# OB Ultrasound for Medicare patient



## okandy (Sep 21, 2012)

76805 has been denied by TrailBlazer because we billed with a screening dx - V28.3, but policy says they cover screening to determine gestational age.  I must be blind because I cannot find a code for this type of screening.  Can anyone help?  What codes can I use to obtain reimbursement for screening ultrasound for Medicare patients?

Thanks to anyone who will help.


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## preserene (Oct 2, 2012)

If you could kindly post the documented procedural notes it will help.
and the diagnosis doctor offered/documented.
With the available data posted, I could think this way:

Most payers today will allow one or two screening ultrasounds and then require you to support any additional ultrasounds for medical need for the particular patient.
And, many payers consider the dating ultrasound to be a screening exam unless the ob-gyn documents a discrepancy between the last menstrual period and the uterine size.
You can code fetal viability only when you know why you have to know whether the fetus is viable. In other words, you need more information from the physician: Is the patient bleeding? And if so, is the patient undergoing spotting (649.5x) or threatened abortion (640.0x)?
Is there a history of a previous abortion (V23.2) or fetal death (V23.5)? Is she cramping (789.0x, if not related to pregnancy, or 640.0x, if related)? Is the cervix dilated (640.0x)?
Can the physician not find a heart beat (656.8x)?...

As for Coding tips, the initial screening US is done after the first trimester of pregnancy  which is a normal routine ultrasound needed to evaluate and specific for a transabdominal US performed after the first trimester and includes measurements & evaluation of fetal anatomy appropriate for the gestational age.
•	For eg   78605, for initial screening with ICD-9 with V28..8, not with follow up screening
•	76816 â€“ (For follow up)  Screening for malformation using US V28.3
•	79811- for all the components of the fetal and maternal evaluation incorporated in code 76805, in addition to a detailed evaluation of the fetal anatomy- the appropriate ICD-9 codes for this  are V28.3, v 71. 89 and 796.5.But generally this 76811 with detailed fetal anatomic examination could be reported only once per pregnancy.


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