Detailed Fetal Anatomy Ultrasound – First Trimester (DFTU)

The Society for Maternal-Fetal Medicine (SMFM) Coding Committee; Robert Rossi, MD Katherine Kohari, MD Barbra Fisher, MD, PhD and Betzaida Martinez CPC, CPMA, COBGC, CPPM

Background

• Multiple societies (AIUM, SMFM, ACOG, ACOOG, SDMS, SFP, and FHS) recommend performing a detailed fetal anatomy ultrasound between 12w0d–13w6d in high-risk pregnancies (“DFTU”)¹. https://doi.org/10.1002/jum.16587
• No unique CPT code exists for the DFTU, leaving clinicians without an appropriate reimbursement method when performing this recommended study.
• These societies recommend using CPT 76811 (detailed fetal anatomy examination, transabdominal approach, single or first gestation), which was designated traditionally for second-trimester anatomy scans.

Coding Instructions

• 76811—CPT® Code in category: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach, single or first gestation.²

• For DFTU, bill 76811 when imaging is medically indicated in the first trimester (12w0d–13w6d) when interpreted by clinicians trained appropriately.³
• Expect that the same patient will need a detailed anatomy examination (another 76811) in the 2^nd or 3^rd trimester.⁴
• Since payors may limit 76811 to one per pregnancy from the same practice, the submission of a 2^nd 76811 from the same practice may result in denials. Previous and new recommendations for DFTU are shown below:

Documentation Requirements

• Indications: Must meet criteria per AIUM/ACOG/SMFM (such as known risk factor, suspected fetal anomaly, or other concern, including an abnormal standard diagnostic obstetric ultrasound).⁵
• Gestational age: Include dates (12w0d–13w6d).
• Scope of exam: Record detailed anatomy views per AIUM standard.³
• Provider credentials: Document that a qualified sonographer and MFM specialist or appropriately trained provider performed and interpreted the scan respectively.¹
• Comparison: If no prior DFTU has been billed, state that DFTU is the first detailed anatomy study during this pregnancy.
• Medical necessity: Clearly indicate why a second 76811 is needed later in the second trimester. When performing the second 76811, be sure to include the medical indication for this study.

Key Reminders

• Be prepared for denial risk if billing 76811 twice in one pregnancy by a single practice, under current payer rules.
• Accurate documentation, payer communication, and tracking are essential to support appropriate reimbursement.

References

1. Multi-Society Guideline for Coding, Billing, and Clinician Training for Detailed Fetal Anatomy Ultrasound in the First Trimester. J Ultrasound Med. 2025;44(7):1519–1521. doi:10.1002/jum.1658
2. CPT® 2025 Professional Edition. American Medical Association.
3. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days. J Ultrasound Med 2021; 40(5):E1–E16. doi: 10.1002/jum.15477. Epub 2020 Aug 27. PMID: 32852128.
4. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. J Ultrasound Med 2019; 38(12):3093–3100. doi: 10.1002/jum.15163. PMID: 31736130.
5. Society for Maternal‑Fetal Medicine. (2021, December 8). Translated ICD‑10 indications for DFTU [PDF]. Society for Maternal‑Fetal Medicine. https://assets.noviams.com/novi-file-uploads/smfm/Practice_Management/Coding_Resources/Translated_ICD-10_Indications_of_DFTU-3218a53b.pdf

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Please submit any questions you may have to the SMFM Coding Committee Ask a Coding Question website (Ask a Coding Question - Society for Maternal-Fetal Medicine). Additional information and resources are also available on our coding website. Thank you very much.