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 [...]