Ob-Gyn Coding Alert

The latest in ultrasound technology 3-D ultrasound is being used to further augment what is seen in the 2-D ultrasound, and while the cutting-edge procedure can be a godsend for patients, it can cause major headaches for coders. 2-D Versus 3-D With 2-D (76805, Ultrasound, pregnant uterus, B-scan and/or real time with image documentation; complete [complete fetal and maternal evaluation]), a physician can move the mother and fetus around to see the limb or ear, but there is no way to determine the structures immediately around it.

Manipulation of the images allows for a bigger picture with a 3-D ultrasound. According to Shelia D. Harris, RT, RDMS, manager for ultrasound services, maternal-fetal medicine/genetics at St. and children, Evansville, Ind., "The appropriate code to report for this procedure is 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computerized axial tomography, magnetic resonance imaging, or other tomographic modality)." The coding committee at ACOG agrees with Harris and is recommending this code as well. Philip N. Eskew Jr., MD, medical director for Women and Infants, Family Life Center, St. Vincent Hospital in Indianapolis, says, "The 3-D is very helpful in recognizing gynecological tumors, sonohysterograms, and facial abnormalities such as a cleft lip. Also, if there is a spine defect seen in the 2-D, the 3-D will allow the physician to pinpoint the exact vertebra involved."

Practices that use the 3-D ultrasound say it is not a replacement for the 2-D, but a supplement. Most patients undergo a 2-D first because interpreting the 3-D image is time-consuming and the equipment is expensive. If there is no reason to believe there is a problem with the fetus, then the time and cost of performing the 3-D ultrasound are not justified. Remember that because 3-D ultrasounds are relatively new procedures, experts say you should demonstrate that the 2-D ultrasound was performed first. Medical Necessity Is a Must "Usually insurance does not cover the image, unless it's a medical necessity," Harris says.

"A2-D ultrasound should be performed first, then, if medically necessary, a 3-D scan. Most likely, if you charge for both, documentation of both studies would need to be sent with the insurance claim," she says. Medical necessity indicates an abnormality that cannot be fully evaluated with 2-D, but additional information can be acquired through the use of 3-D such as locating an ectopic pregnancy (633.x) only if it is a confirmed finding. "If the physician is simply looking for a problem," saysMelanie Witt, RN, CPC, MA, an ob/gyn coding expert based in Fredericksburg, Va., "you should code the symptoms or use the antenatal screening code V28.8."

Joshua Copel, MD, director of obstetrics at Yale/New Haven Hospital, has been successful in receiving reimbursement for 3-D [...]