# OB vs. Non-OB Ultrasound



## cwpierce (Nov 8, 2012)

This is a bit of a brain teaser for me so I will post my line of thinking. I had a Doctor call to ask which US code to use in the situation of a patient being seen for amenorrhea (626.0). The doctor does an ultrasound and comes back with a threatened abortion dx (640.03).
I'm thinking ok, we bill for an OB ultrasound  but then the doctor says that she didn't see a fetus. Well now, if there is no fetus then how can we be using a dx of 640.03 when there is nothing there to be threatened? Maybe the doctor means a missed abortion (632)...but I'm still awaiting a chance for futher discussion with the doctor about this. In the meantime, if it is truely a missed abortion would I use an OB ultrasound code with a screening dx (v28.8x) and a missed abortion dx of 632...... or ...... because there is no fetus, use a Non-OB ultrasound code and use the amenorrhea dx of 626.0? Basically, which ultrasound is coded if it is our first ultrasound and we find that the patient was pregnant but miscarried before she ever stepped into the office for her missed periods?


Thanks for any help on this one.


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## preserene (Nov 8, 2012)

If the doctor‘did not see a fetus', but documented it as ‘threatened abortion' we have to hold on to her diagnosis. We will not go to say ‘missed abortion' when she did not document so. It goes to say that she meant, diagnosed and documented a pregnancy when she documents “threatened Abortion”. We can not go for a non OB ultra sound just based on the fact that she did not find a fetus there. (The fetal poles can be seen only after 5weeks of pregnancy. The fetal heart only at or after 7 weeks of pregnancy). This pregnancy could still later prove to be a viable pregnancy. Needs yet another one or two US to say it is a live pregnancy or missed abortion.
The doctor once documented it is “threatened abortion, we would go for OB US. Even if it is documented Missed Abortion, would go for OB US , especially on ultrasound point of view.
Hope it is understandable.


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## cwpierce (Nov 9, 2012)

Once again preserene, thank you for your insights.


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