Ob-Gyn Coding Alert

Question:  My ob-gyn is performing ultrasounds for reasons like “repeat anatomy.” In other words, he’s doing them for no reason other than that he couldn’t visualize certain areas because the patient’s pregnancy was too early on for the first one. Although I have tried to convince my ob-gyn otherwise, he says there is a diagnosis code out there that states “repeat anatomy.” What is he talking about?

New York Subscriber

Answer: No, you won’t find any such diagnosis code.

A repeat is a follow-up exam, and you should report that with 76816 (Ultrasound, pregnant uterus, real time with image documentation, follow-up [e.g., re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan], transabdominal approach, per fetus).

But keep in mind that CPT^® indicates that if all of the required elements of a complete ultrasound are not performed/documented, you have to bill instead a limited ultrasound code. You need to ask yourself whether you incorrectly billed a complete ultrasound the first time that did not meet the criteria for doing so.  If the second ultrasound is done to complete the ultrasound requirements of the code you have already billed, some payers will tell you this is not a billable service.

If you are allowed to bill for the repeat scan, the diagnosis is the same as the first one the ob-gyn did. This might be to complete a scan for a malformation (V28.3, Screening for malformation using ultrasonics) or to complete a fetal anatomic survey (V28.81, Encounter for fetal anatomic survey) when he initially did not find any problem.

ICD-10: When ICD-9 becomes ICD-10 in 2014, you’ll report the following equivalent for both V28.81 and V28.3, which is Z36 (Encounter for antenatal screening of mother). Note that in ICD-10, you do not differentiate the reason for the screening the way you do in ICD-9.