# Limited pelvic us



## amandahollis80 (Jun 29, 2011)

A pregnant patient comes into the ER with abdominal pain. The ER physician wants to perform a limited US on the patient to look at the ovaries only to r/o ovarian torsion. They are not looking at anything else except the ovaries. The US is not related to the patient's pregnancy. Would you code this 76815 or 76857?


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## OCD_coder (Jun 29, 2011)

I would still use the 73815-26 because the ED physician is still examining the pregnant uterus in addition to checking the ovary.  He is checking to be sure that she there is no placenta previa.  It is a better fit, not perfect, but it doe not fit the 76857-26 that well.


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## preserene (Jun 29, 2011)

How many weeks of pregnancy and was it transabdominal/trans vaginal or both?


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## amandahollis80 (Jun 29, 2011)

Not sure how many weeks. It is a hypothetical scenario. the ER physicians are wanting to know. They are asking our Radiologist how it should be ordered. It will be transabdominal. They are not looking at the pregnant uterus at all. They are only wanting to visualize the ovaries.


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## preserene (Jun 29, 2011)

How could we code without knowing the weeks of pregnancy?  I would definitely quiry the Physician before assigning the code,
because there are different codes for weeks of pregnancy- with FETAL AND MATERNAL STRUCTURAL EVALUATION IN ONE CODE, 
WHICH COULD OBVIOUSLY INCLUDE THE ANATOMICAL STRUCTURE OF THE MATERNAL PELVIC ORGANS.
Well, your scenario looks like more for maternal anatomical structural evaluation only..; being a pregnant uterus it is needless to say that it  goes with evaluation of the fetus also.
If it is below 14weeks pregancy, i would go for 76801/ + 76802.
If it is 14weeks above, 76805/ + 76810.

[ In a retrospective review assessing the risk of torsion among pregnant patients with adnexal tumors > 4 cm, 51% of torsions occurred in tumors measuring 6 to 8 cm in diameter with an overall incidence of 22% in this group of patients. Furthermore, the highest hazard rate of torsion occurred between 15 and 16 weeks' gestation with 60% of torsions occurring between 10 and 17 weeks' [18]. ]
That is one of the reason I wished to know the period of pregnancy, to assign the code.
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 Within the two codes you suggested, *for the emergency nonobstetrical cause to be  ruled out*:
The code 76815 go for limited US-limited with respect to fetal and placental. It does not mention/specify about maternal structural evaluation. So I would stay away from this code.

If the* doctor's documentation is as "limted and for ovarian pathology for assessment AND didi not mention about  any details of the fetal examination *, then
the code 76857 limited  can be given a merit for the non committal route but as 'pelvic US" for a "*suspected non ostetrical condition*"  as a quick look limited assessment of the pelvic organs like ovaries,paraovarian, adenexal or tubal pathology. Why not?
It says (eg) follicles but can include any structure on the way, within the area of assessment. 
The description *"limited and nonobsterical cause" *, is all  that is important here I feel to assign the code, with the avaialble info.
BUT above all, better try to assign acode, getting more details of the pregnancy and the diagnosis.
Thank you .i hope this is just a note to help.


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## bigredcag (Jul 7, 2011)

if only the ovaries are looked at on a pregnant person the it is 76815 limited U/S . The patient is pregnant and that is priority. I see this often as docs are verifiying an ectopic or whatever else is wrong but are not meeting the requirements of other u/s codes. Weeks of gestation only come into play when you are doing a more detailed U/S.
hope this helps.


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