# OB US codes or non-OB US codes



## Kimberley (Aug 27, 2010)

76856/76830 or 76815/76817????


INDICATION:  683.1.  Ectopic pregnancy.  Patient has history of tubal ligation, with 
positive pregnancy test.
TECHNIQUE:  Ultrasound evaluation of the pelvis was performed using transabdominal 
and transvaginal technique.  Static images are submitted for review.  COMPARISON:  None. 
FINDINGS:  The uterus measures 9.5 x 3.7 x approximately 4.0 cm.  The endometrium 
measures 1.7 cm in thickness, LMP 6/25/10.  No gestational sac is seen within the uterus. The right adnexa could not be seen transvaginally.  It also was not seen transabdominally.  On transvaginal exam, the left ovary is seen adjacent to the uterine fundus, measuring 
2.6 x 1.5 x 2.3 cm.  There is no pelvic free fluid identified.  In the left adnexa, there is a focal hypoechoic structure, with echogenic rim measuring 2.0 
x 1.6 x 1.9 cm.   On color Doppler, there is prominent vascular flow in the periphery of 
this structure.  Ectopic pregnancy is suspected.  
IMPRESSION: 1.  No gestational sac is seen within the uterus.  Nonvisualization of the right ovary.  No 
gross right adnexal mass is seen. 2.  The left ovary appears separate from a hypoechoic structure with echogenic rim and 
prominent peripheral vascular flow, measuring 1.9 x 2.0 x 1.6 cm, suspicious for an 
ectopic pregnancy in the left adnexa.  Additional evaluation is recommended. 3.  Please note the patient by LMP 6/25/10, should be 6 weeks, 0 days gestation.  The above was discussed with Doctor Penney, covering for Doctor Conley, 8/06/10, 8:40 
a.m.  The patient was instructed to go to Riverview Medical Center Emergency Room at


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## Lisa Bledsoe (Aug 27, 2010)

I would use non-ob codes because the description of the ob codes is "pregnant uterus".  You don't have a pregnant uterus here.


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## preserene (Aug 27, 2010)

yes as there is no transvaginal during these weeks of pregnancy separately for ectopic,you are right. 
*But* I feel I do not agree with the point on, NO PREGNANT UTERUS' reason to delinate form coding from This section of OBSTYETRICS.
Because, it is a pregnant situation and ectopic necessarily means a pregnancy outside the uterus(including the cornual pregnancy). That should not delinate the 'pregnant status' of an ectopic.
So obstetrical transvaginal US sould be reported with 76817, immaterial of the time of pregnancy and site of ectopic/prenancy
This is just my openion by all means with due relevance to the US (picture)report too.
The whole  picture of US is more in favor of ectopic and the doctor impression too.

Thank you.


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## Kimberley (Sep 1, 2010)

So, I should use 76856 and 76830??  What would be the most appropriate dx code?


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## Beany011178 (Sep 1, 2010)

I would use the 76817 because there is a positive pregnancy test.


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## preserene (Sep 1, 2010)

OB US codes or non-OB US codes 

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76856/76830 or 76815/76817????


INDICATION: 683.1. Ectopic pregnancy. Patient has history of tubal ligation, with 
positive pregnancy test.

your Physician has already documented' Indication for US Ectopic pregnancy'
 I would like to suggest the diagnosis code as: 633.90, 793.6-(includes US examination);  abdominal area including retroperitoneum ; plus 
diagnosis code for positive preg test and the Vcode for personal history of  surgery-previous tubal ligation.

If I were in your shoes, I would assign for 76856 ( transabdominal US, and 76817 ( for tranvaginal), if 76801 abdominal not acceptible.

You know after all Ectopic Pregnancy(to start with), itself a 'cat-on-the-wall' scenerio and it can be for all theoretical, practical and clinical purposes discussed under Obstetrics and Gynecological condition as well, though, the cause is by all means a pregnant status.
 76856 when we do not have a separate code for US abdominal during early weeks of pergnancy with desciption fitting into that, 76801 though, somewhat. 

So no harm in assigning 76856 for abdominal, complete examination,real time, of the pelvis and its adnexal area is mandatory.
*76856/ 76801 for transabdoninal is payer,s discretion but the transvaginal as for me , I would strongly suggest 76817.
*
Let us see what the experts opt to say. 
It could be one of the gray areas which gets us into fix.
Thank you.


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