Ob-Gyn Coding Alert

Question: When our fertility patients get pregnant with twins and the ob performs the ultrasound, we have been using V23.0 and 651.03 to indicate medical necessity. Is this correct or should we be using a different ICD-9 code?

Washington Subscriber

Answer: ICD-9 coding rules state that you should not use the V23 codes (Supervision of high-risk pregnancy) with an obstetric chapter CPT code. Consequently, you should use 651.03 (Twin pregnancy; antepartum condition or complication) in this case because she is no longer infertile, but pregnant with twins.

If the ob is simply doing a screening ultrasound (76815, Ultrasound, pregnant uterus, real time with image documentation, limited [e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], one or more fetuses; or 76817, Ultrasound, pregnant uterus, real time with image documentation, transvaginal), you can link the CPT code to V28.8 (Other specified antenatal screening). Make sure you list 651.03 first, followed by V28.8.