Ob-Gyn Coding Alert

Question: I keep reading information that payers should reimburse medically indicated ultrasounds if we use the correct codes. However, I cannot find some diagnosis codes for some indications. They are as follows:

Texas subscriber

Answer: Most payers today will allow one or two screening ultrasounds and then require you to support any additional ultrasounds for medical need for the particular patient.

And many payers consider the dating ultrasound to be a screening exam unless the ob-gyn documents a discrepancy between the last menstrual period and the uterine size.

The same goes for the routine anatomy scan and the nuchal scan. That said, ICD-9 is going to clarify some of these screening codes in October. For instance, you-ll expand V28.8 (Other specified antenatal screening) to a fifth digit to account for different types of screening scans. You-ll also have a new code category (V89) for suspected fetal conditions not found.

But until Oct. 1, you have only the current options:

You can code fetal viability only when you know why you have to know whether the fetus is viable. In other words, you need more information from the physician: Is the patient bleeding? And if so, is the patient undergoing spotting (649.5x, Spotting complicating pregnancy) or threatened abortion (640.0x)?

Is there a history of a previous abortion (V23.2, Pregnancy with history of abortion) or fetal death (V23.5, Pregnancy with other poor reproductive history)? Is she cramping (789.0x, if not related to pregnancy, or 640.0x, if related)? Is the cervix dilated (640.0x)?

Can the physician not find a heart beat (656.8x)? Or does the physician need to know for some other reason?

  If the physician finds a uterine size-date discrepancy, you can use 649.6x. But if you are simply dating the pregnancy, this is a screening ultrasound, and V28.8 applies. Again, you can use the V code for insufficient prenatal care (V23.7), but if this is the same scan you do on all pregnant patients, just later in time, then this is screening.

Finally, you should consider evaluating fetal growth a screening scan unless the ob-gyn suspected a problem with the fetus or the ob-gyn is doing it because the mother has diabetes or some other condition that warrants this type of serial evaluation.

-- The answers for Reader Questions and You Be the Coder provided by Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.