Reimbursement Advisor

Ultrasound included with D&C?

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Q I performed 2 dilation and curettage (D&C) procedures with ultrasonic guidance. One was for retained placental fragments; the other, for manual removal of a placenta after elective termination due to severe fetal abnormalities. I am unable to find a code for the ultrasonic guidance to use in addition to the procedure codes—are these services considered inclusive in the surgical procedures? Would I just use 76999 (unlisted ultrasound procedure)?

A While ultrasound guidance is not specifically bundled into the delivery/abortion codes, you cannot count on it being reimbursed separately when done at the time of a D&C. The payer may decide that it is not medically indicated, or that it is routinely performed by the physician in all cases and is thus part of his or her procedure technique. The most appropriate code in this case would be 76986 (ultrasound guidance, intraoperative), rather than the unlisted procedure 76999.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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