Wiki How to bill for office ultrasound

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K.Vradenburg1

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In my Women's OB/GYN clinic the providers do a ultrasound on the first visit to identify a postive pregnancy and they charge a level 5. Is this the correct way to get paid for the ultrasounds? I know medi-cal only covers 1 ultrasound at 20 weeks.
 
No you absolutely cannot bill a high visit to avoid charging for the actual service provided. I cannot imagine that any payer will pay a level 5 for a V code for pregnancy.
 
That is what I thought but was not sure because the providers were using 626.0 as diagnosis then charging level 5 plus doing the ultrasound for the first "identify pregnancy" visit. So correct me if I am wrong the providers need to charge the diagnosis code V72.4X plus the office visit level and the ultrasound code?
 
626.0 is an incorrect diagnosis for a patient that thinks they are pregnant. This is a common mistake but it is the wrong code. 626.0 is in the category 626 which disorders of menstruation and other abnormal bleeding from female genital tract. If the category does not fit the patient then the code within the category is also incorrect, because the code just an extension of the category. To miss a few periods and think you are pregnant is not absence of menstruation, that code is for when the patient has never had a period prior to the age of 15 or has a sustained absence of 6 months or greater. I doubt that that definition fits the majority of your patients. If it is known that the patient is pregnant then you use a V 28 code for antenatal screening. If they are using it confirm then it is a V 72.4- code. Yes you use the E&M plus an ultrasound code. It will probably not be paid as that is not a common method to confirm a pregnancy.
 
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