# No Fetal Cardiac Activity?



## Chanke (Dec 14, 2010)

How would you code an Ultrasound for the following:

Patient had a positive pregnancy test, unsure of dates.  Ultrasound shous no IUP, no ectopic/adnexal masses.

Can't really code it as an OB ultrasound.


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## kbazarte@yahoo.com (Dec 14, 2010)

If the pt.'s chart documents "pregnancy" I would still use pregnancy codes.

If the problem is fetal heart tones I would use 659.73.

If this is a very early pregnancy a fetal sac my not be able to be visualized.


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## preserene (Dec 14, 2010)

Your thread needs more clarification. Your title was no fetal cardiac activity;so that goes to say there was a gestational sac found in the ultra sound?. but your details inside goes to say that there was no  IUP, nor ectopic pregnancy. this rules out the title of 'no fetal cardiac activity', while there is no documented gestational sac visualized. SO, no ultrasound sign of gestation there. With this scenario, I would go for nongestational ultasound- transvaginal, trans abdominal, whatever was performed.
Just a qualitative pregnancy test alone cannot confirm pregnancy. Even some beta HCG results can go for false positive tests for pregnancy ,for eg, trophoplastic diseases which are considered to be non gestational.

So ultra sound obstetrical have to have some ground to place them in obstetrical US.
This may need beta HCG test and another repeat US after a week or so to consider to place for obstetrical US
Does this post (my response) make some sense?


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## Chanke (Dec 14, 2010)

Your responses  both make sense.  The order for the ultrasound states pregnancy, unsure of dates.

The ultrasound report shows zero evidence of a pregnancy, uterine or otherwise.  It specifically mentioned no fetal heart tones, no gestational sac, yolk sac, etc.

It just kind of threw me.  Usually I see fetal demise, but never have I seen no evidence of pregnancy before.


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## preserene (Dec 14, 2010)

Wel, may be  you can go with your obstetric US CPT code then, and support with the Vcode 71.89


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## msrd_081002 (Dec 14, 2010)

*RE: Use of OB US Vs Non-OB US Codes*


Use of OB Ultrasound Codes Versus Non-OB Ultrasound Codes 
CPT Assistant:

CPT states, through its companion publication, the *CPT Assistant*,5 that the 
                               use of *OB ultrasound codes are appropriate anytime the patient has been established to be pregnant, by any method or means*, and the indications for the ultrasound study might be or could be* pregnancy-rela*ted, regardless of whether the outcome might not confirm a pregnancy, or might produce a diagnosis that is *not pregnancy-related*. 

 For the patient who has *not* been diagnosed as pregnant, and the indications for the ultrasound study are *not pregnancy-related*, the use of non-OB ultrasound codes is appropriate, regardless of whether the outcome of the study shows a *pregnancy or complication related to pregnancy.* 

Per guideline, I'll code PDX as *V72.4*1 &  CPT 76801.(I find the information provided in the query post insufficient.)
As Ultrasound shows no IUP, no ectopic/adnexal masses, the apt code 'd be v72.41.

PS: http://www.acr.org/Hidden/Economics...stetricalUltrasoundCodingRadiologyReport.aspx

Thanks


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## preserene (Dec 15, 2010)

The PHYSICIAN'S order was for PREGNANCY,UNSURE OF DATE. Well we stand by that statement. The findings are not found but she does not state that the pregnancy is negative. The pregnancy test has come out as positive. The physician has not declared it as negative yet. Within the realms of medical necessity she would still wait for another test and US to confirm. 

V72.41  is for pregnancy examination or TEST negative result; here the pregnancy test has become positive though. And the negativity is not for sure though at this stage
No obstetrician would be satisfied with the transabdominal approach of Ultrasound wherein they did not find a intrauterine/extrauterine  gestational sac search. At very early weeks of pregnancy, the presence or absence of IU or extrauterine gestational sac is documented only after transvaginal US.
Point2:
As for my knowledge the CPT 76801 would not be appropriate in the event of the approach not being mentioned. Query your doctor whether it was transvaginal or both or transabdominal alone. Iam sure the physician would have documented and if (s)he did not do transvaginal, (s)he would have documented  why not also.
By and large, pregnancy at this stage need transvaginal ultrasound for validation.

Point3:
V code I again go for the 71. Series.
We cannot be going with the CPT assistant alone having it as gold standard for all the  cases we meet with; .we have to assign as per the clinical scenario and by analysis which is right  and each case has its own merit of validation to be individualized and all the more with physician document. Doubt like this should be clarified with the provider with all these probablities in our mind.


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