Wiki Follow up medication abortion

[dbolivar1]

Hello,

Patient came in for a post medication abortion follow up. Patient took medication and had bleeding followed by passage of tissue. Today she reports no bleeding or pain. Non-ob US was performed, Impression: Completed medication abortion.

Is Z09 and Z87.59 the proper DX to use?


Thank you!

 

[Cmama12]

Hi, I probably would just use the Z09 based on what you wrote. Not sure what the complication code refers to? Also, please note that the ultrasound should be coded as OB anytime it is related to a pregnancy.

CPT states, through its companion publication, the CPT Assistant,(Oct 2001) that the use of OB ultrasound codes are appropriate anytime the patient has been established to be pregnant, by any method or means, and the indications for the ultrasound study might be or could be pregnancy-related, regardless of whether the outcome might not confirm a pregnancy, or might produce a diagnosis that is not pregnancy-related. For the patient who has not been diagnosed as pregnant, and the indications for the ultrasound study are not pregnancy-related, the use of non-OB ultrasound codes is appropriate, regardless of whether the outcome of the study shows a pregnancy or complication related to pregnancy.

 

[dbolivar1]

Hi, I probably would just use the Z09 based on what you wrote. Not sure what the complication code refers to? Also, please note that the ultrasound should be coded as OB anytime it is related to a pregnancy.

CPT states, through its companion publication, the CPT Assistant,(Oct 2001) that the use of OB ultrasound codes are appropriate anytime the patient has been established to be pregnant, by any method or means, and the indications for the ultrasound study might be or could be pregnancy-related, regardless of whether the outcome might not confirm a pregnancy, or might produce a diagnosis that is not pregnancy-related. For the patient who has not been diagnosed as pregnant, and the indications for the ultrasound study are not pregnancy-related, the use of non-OB ultrasound codes is appropriate, regardless of whether the outcome of the study shows a pregnancy or complication related to pregnancy.

I thought I need to add another dx to Z09, Use additional code to identify any applicable history of disease code (Z86.-, Z87.-) (Z86-Z86.79, Z87-Z87.898, ). Do I need to use visit 99024, if the procedure was done in the same location getting the follow up? I'm still learning, I work in the OB Triage and center of reproduction. I really appreciate your help.
Even if the provider states they used a Non-OB US 76830, I should code 76817? Just double checking

 

[Cmama12]

Hi, in this case there is no applicable history of disease. Since it was a medical abortion, then no you don't need to use 99024 because there is no global period like you would have for a surgery. And yes, the US should be coded as OB since it relates to a pregnancy.