Primary Care Coding Alert

Question: The FP meets a 28-year-old established patient who is 24 weeks pregnant at a local hospital; she says she has been "throwing up almost constantly" for four days. During a level-four E/M service, the FP discovers that the patient is also experiencing abdominal cramping, but no diarrhea or fever. He orders a limited ultrasound to check on the fetus. The fetus shows no signs of complications due to the mother's condition, so the FP discharges the patient with prescriptions, and instructions to report to the office if her vomiting has not abated within four days. Final diagnosis was "hyperemesis grav. w/metabol. dist. No dehydration." How should I code this scenario? Can we report for the ultrasound, since it occurred in the hospital?

Montana Subscriber

Answer: The E/M and ultrasound are separately codeable; however, since the FP used the hospital's equipment for the ultrasound, you'll need some modifier help to get the claim ready for filing.

On the claim, report the following:

• 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], 1 or more fetuses) for the ultrasound
• Modifier 26 (Professional component) appended to 76815 to show that you are only coding for the FP's interpretation and report of the ultrasound (the facility will bill for the use of the ultrasound equipment)
• 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity ...) for the E/M
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99214 to show that the E/M and US were separate services
• 643.13 (Hyperemesis gravidarum with metabolic disturbance; antepartum condition or complication) appended to 76815 and 99214 to represent the patient's hyperemesis and current episode of care.