Ob-Gyn Coding Alert

Question: I billed 76801 with V72.42 to Anthem and received a denial for -not medically necessary.- My ob-gyn's notes indicate he performed the ultrasound for dating purposes. What diagnosis should I use? Colorado Subscriber Answer: Go back and read your ob-gyn's notes. If this is a routine screening, you can choose between V28.3 (Antenatal screening for malformation using ultrasonics), which includes -routine fetal screening not otherwise specified,- or V28.89 (Other specified antenatal screening) which you would use to report -other- reasons for antenatal screening. As you have indicated, you billed 76801 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester [< 14 weeks 0 days], transabdominal approach; single or first gestation). The ob-gyn did not also report a fetal survey, so V28.81 (Encounter for fetal anatomic survey) would not apply to this situation. On the other hand, if he documented a uterine sizedate discrepancy in [...]