Ob-Gyn Coding Alert

Ultrasound screening is increasingly a more common practice in obstetrical care. According to a recent technical bulletin from the American College of Obstetricians and Gynecologists (ACOG), 70 percent of all pregnancies in the United States undergo routine ultrasound evaluation even though the clinical benefits of routine evaluation have not been established. Nevertheless, it remains a growing part of the obstetric care because it helps reduce the incidence of labor induction in pregnancies that have gone past their suspected post-due date, and helps decrease the frequency of undiagnosed major fetal anomalies and undiagnosed twins. In addition, ob patients are beginning to expect ultrasound as part of their routine obstetric care.

How many ultrasounds are allowed to be performed per pregnancy, and which specific codes should be used? asks Sandra Flores, certified coding specialist in the ob/gyn department at Texas Technical School of Medicine in El Paso, TX. Both of these questions are commonly heard from subscribers to OCA.

Part of Global?

Many patients and some insurance companies expect ultrasound to be included in global ob billing. Its definitely not part of global, says Lisa A. Lorence, coding specialist for Toledo Clinic, Ob/Gyn, in Toledo, OH. Lorences view is consistent with CPT definitions and a clarification by the AMA published in the April 1997, CPT Assistant, that there is no inclusion of diagnostic ultrasound in the global ob package. Ultrasounds are a separate procedure and should be reported as such. This does not mean that all insurance payers will see it this way, but when it comes to correct reporting, ultrasounds are not part of routine ob global care.

The CPT OB Ultrasound Codes

So, if correct reporting requires separate codes, which codes should you use? The common CPT codes are found in the Radiology Diagnostic Ultrasound section of the CPT, but the descriptions of these codes are vague, says Walter C. Blackham, chairman of the Radiology Business Management Associations (RBMA) coding committee. Coders will always have trouble with these codes, he explains. There is no real good explanation for [how to use] them. Melanie Witt, RN, CPC, MA, program manager for ACOGs department of coding and nomenclature agrees. There are no good definitions for the ultrasound codes as they appear in the CPT, she says. ACOG and the American Institute of Ultrasound in Medicine (AIUM) are working to remedy this situation. For now, the following descriptions of the most common codes and problems will assist the coder in choosing the right codes.

The Complete, Limited and Follow-up Ultrasounds

According to a January 1998 ACOG opinion paper, A complete ultrasound (echography) of the pregnant uterus, which involves a complete fetal and maternal evaluation, is for the most part, an anatomic evaluation. For the maternal evaluation, [...]