Coding for OB Ultrasounds and Annual Exams

Coding for OB Ultrasounds

Are you confused about ultrasound coding? You’re not alone. Here are some tips that should take the mystery out of ultrasound coding and help you to get the payment that you deserve.

Unravel Diagnosis Codes for Ultrasounds

Some coders have questions about diagnosis codes for medically-indicated ultrasounds. If the correct codes are used, will payers reimburse?

For instance, if the following reasons for an U/S are provided, what will the likely outcome for payment be?

• Determine fetal viability/confirm cardiac activity
• Uncertain dating/estimate gestational age
• Evaluate the fetus’ condition in late registrants for prenatal care
• Evaluate fetal growth (for instance, in the absence of already-diagnosed SGA or LGA).

Most payers today will allow one or two screening ultrasounds and then require you to support any additional ultrasounds for medical need for the particular patient.

And, many payers consider the dating ultrasound to be a screening exam unless the ob-gyn documents a discrepancy between the last menstrual period and the uterine size.

You can code fetal viability only when you know why you have to know whether the fetus is viable. In other words, you need more information from the physician: Is the patient bleeding? And if so, is the patient undergoing spotting (649.5x) or threatened abortion (640.0x)?

Is there a history of a previous abortion (V23.2) or fetal death (V23.5)? Is she cramping (789.0x, if not related to pregnancy, or 640.0x, if related)? Is the cervix dilated (640.0x)?

Can the physician not find a heart beat (656.8x)?...