Reimbursement Advisor

Use OB or GYN code if fetal pole is absent?

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Q When a patient has a sonogram to check for fetal heart tones and only a gestational sac (g-sac) with no fetal pole is found, is the sonogram coded as a limited OB or a GYN ultrasound, because the patient is not pregnant? Also, for a diagnosis of g-sac with no fetal pole, is it correct to code a blighted ovum (usually these patients are less than 10 weeks pregnant)?

A Technically, when a gestational sac is present, the patient is still pregnant, so the GYN codes are inappropriate. And yes, you should assign the diagnostic code for blighted ovum (ICD-9-CM code 631).

If the purpose of the ultrasound is only to check for fetal heart tones, then the correct code is 76815 (ultrasound, pregnant uterus, real time with image documentation limited [eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], one or more fetuses).

While this scan could be performed transvaginally, the amount of work in checking only for fetal heart tones is significantly less than that involved in the OB transvaginal procedure.

Therefore, I recommend that you use the limited ultrasound code even if a vaginal probe was used.

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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