Ob-Gyn Coding Alert

Question: I have an ultrasound question. The physician requests a second-trimester transabdominal ultrasound to check for possible birth defects in a patient who is over age 35. The ultrasound starts out as a transabdominal. However, if the baby is in a difficult position to obtain all pictures needed for a complete exam, the technician uses transvaginal probes to complete the exam. Because the ob-gyn uses both transabdominal and transvaginal probes, can I bill for both services (76817 and 76805 with V28.3 and 659.63)?


Oregon Subscriber


Answer: CPT guidelines allow you to report both a transabdominal (76805, Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester [> or =14 weeks 0 days], transabdominal approach; single or first gestation) and a transvaginal (76817, Ultrasound, pregnant uterus, real time with image documentation, transvaginal) scan on the same patient--as long as the additional approach is medically indicated.

Unfortunately, you won't find any ICD-9 code for a fetus in a difficult position for completing a scan, so you will have to take your chances with the same diagnosis.

In the case of ICD-9 coding, you would only report 659.63 (Elderly multigravida; antepartum condition or complication) if the patient's age was complicating the pregnancy management or management of the fetus. So, if your physician is screening for fetal abnormalities because of the patient's age, 659.63 is appropriate (rather than V23.81, Elderly primigravida).

Don't forget: The 659.63 should be your primary diagnosis followed by V28.3 (Screening for malformation using ultrasonics). If this screening is not due to the patient's age, your diagnosis code is V28.8 (Other specified antenatal screening) or V28.3 only.