Ob-Gyn Coding Alert

Question: My ob-gyn is treating a patient who is bi-polar and has an intellectual disability. She is on Medicare and comes in for her annual. She cannot tolerate a pelvic exam, so we have to do a pelvic ultrasound in order to evaluate her. What ICD-10 code should I use for the ultrasound?

Illinois Subscriber

Answer: If you don’t want an outright denial, I would contact the Medicare representative for prior authorization. The ICD-10-CM codes you can use will certainly result in a medical necessity denial. Your primary code will be Z01.419 (Encounter for gynecological examination (general) (routine) without abnormal findings), and your secondary code will be one of the F70-F79 (…Intellectual disabilities) codes.