Wiki 84703 to rule out pregnancy

[SheriFaganCPC]

I have been out of the OBGYN coding for a few years and need some help, I have a provider who is billing 84703 with DX code Z32.02 and we are starting to see a lot of denials for this code especially with BCBS. When I worked OBGYN the physicians always ordered 81025, I feel like 81025 is the correct code to be using. When I research 84703 on Codify it says it is typically a blood sample. But everyone I have spoken to says it is also a urine test as well, so I am so confused and frustrated of researching and not getting anywhere with this. I feel like I am going in circles.

 

[CBLENNIE]

Is your provider actually performing hCG; qualitative testing or is the provider just doing a urine dipstick pregnancy test? That is the first question to ask yourself whether 84703 or 81025.

If your provider is performing hCG; qualitative testing, then 84703 is the correct code for the lab test performed. However, from what I found when I did a bit of research is that the DX you are using Z32.02 isn't commonly covered for 84703. I looked at the policies as well as some clinical bulletins from Quest, and your DX isn't covered with 84703.

 

[SheriFaganCPC]

The patient is coming in for a DEPO shot and they do 84703 to rule out pregnancy. There wouldn't be another DX code I could use for the 84703 since we are trying to rule out pregnancy, right?

 

[csperoni]

Unless there is a medical indication for the pregnancy test, Z32.02 (if negative) is the correct ICD10. As mentioned by @CBLENNIE , qualitative hCG is not typically covered as a screening. I have never dealt with an obgyn practice that performed 84703 in house. I would also stress to confirm that is the test you are performing and not 81025 for pregnancy dipstick.
The reason Z32.02 is not typically a covered diagnosis for 84703 is that is a much more involved test, and 81025 is what would be performed in almost all situations for a pregnancy screening.