Ob-Gyn Coding Alert

Question: What codes should I use for the medical treatment of an ectopic pregnancy? Also, what procedure code should I use for the excision of a suburethral diverticulum?

New Mexico Subscriber

Answer: You will bill the medical treatment of an ectopic pregnancy using E/M codes, serial ultrasound, repeat HcG testing and possibly injection of Methotrexate. Therefore, you need to have the physician note that indicates the treatment done on any given day (usually over a 7-8 day period) to determine what you can bill.  

The same rules apply to Methotrexate as to all injections when it comes to billing them with an E/M service. The J code would be J9260 if the dose was 50 mg, and of course, you would also bill the injection administration 96372 (Therapeutic,prophlactic,or diagnostic injection, [specify substance or drug], subcutaneous or intramuscular) if allowed by the payer. If your physician is using oral Methotrexate and supplied the drug, the code would be J8610 (Methotrexate; oral, 2.5 mg), but be aware of the dosage given, at typically it is 60mg in 2 doses.

You would have to determine the type of ultrasound performed, and if you sending the tests out to a lab for HcG testing, you would not report that on a claim.

A urethral diverticulum excision is 53230 (Excision of urethral diverticulum [separate procedure]; female). The term "urethral" and "suburethral" are interchanageable for coding purposes. Note that this is a CPT® "separate procedure," so if other procedures were performed, bundling may be an issue.