ED Coding and Reimbursement Alert

Question: A 26-year-old patient who is 24 weeks pregnant presents to the ED; "I been throwing up constantly for three days", she tells the nonphysician practitioner (NPP). During a level-four E/M  service, the physician discovers that the patient is also experiencing abdominal cramping, but no diarrhea or fever. He orders a limited ultrasound (US) to check on the fetus, which shows no signs of complications due to the mother's condition. The ED physician discharges the patient with prescriptions, and instructions to report to the obstetrician if her vomiting has not abated within two days. Final diagnosis was "hyperemesis grav. w/metabol. dist. No dehydration." How should I code this scenario?North Carolina SubscriberAnswer: You can code the E/M and ultrasound separately, but you'll need to stick a modifier on each code in order to report the encounter successfully. On the claim, report the following:76815 (Ultrasound, pregnant uterus, real time with image documentation, [...]