Wiki Inconclusive fetal viability, O36.80X0

[jmeberst314@gmail.com]

I could really use some coding assistance on the following scenario.

A patient comes in for her delayed menses appointment; on the ultrasound they discover a gestational sac but no fetal pole and no fetal heart rate, the provider has the patient come back in a few weeks as the patient may be to early in her pregnancy to confirm. Would it be correct to code O36.80x0 along with 76817? The office visit we've been coding as Z32.00 and appropriate E&M visit.

Any assistance would be appreciated, thank you!

 

[danteeg65]

Erik Brown CPC

Hello. I am an OB/GYN specialty coder as well. My name is Erik.
So as far as the diagnosis codes for this are concerned, if the U/S was done transvaginally (which 76817 is correct for that especially when in the 1st trimester), then you would determine the correct diagnosis and state of the pregnancy by the Estimated Gestational Age of pregnancy (EGA) or days since last menstrual period (LMP)
If the EGA is 6 weeks or greater and reveals an empty sac with no fetal heart beat and the size of the sac is measured as greater than 25 mm diameter you would assign O02.0- Blighted Ovum/Molar Pregnancy.
If this Ultrasound is done less than 6 weeks EGA without any sign of fetus and an empty sac you would assign O36.80x0-Inconclusive Viability and the Physician should schedule followup U/S for 3-7 days.

When you bill your E/M visit and the Ultrasound on the same claim or code it on the same chart encounter append mod 25 to the Office visit. Example
99213-25, 76817

 

[jnjradio]

Hi Erik,

I am hoping you can help me ... are you able to guide me to where you found this information?
"If the EGA is 6 weeks or greater and reveals an empty sac with no fetal heart beat and the size of the sac is measured as greater than 25 mm diameter you would assign O02.0- Blighted Ovum/Molar Pregnancy.
If this Ultrasound is done less than 6 weeks EGA without any sign of fetus and an empty sac you would assign O36.80x0-Inconclusive Viability and the Physician should schedule followup U/S for 3-7 days."

Jodi Cornell, CPC
OB/GYN Coder

 

[mitchellde]

To code for a blighted ovum/molar pregnancy, the provider or radiologist must be the ones to render this diagnosis. The coder is not allowed to interpret an ultrasound based on the reported findings.

 

[jdavenport02]

Assigning Code O36.80X0

If the impression reads the following (2 different scenarios), would assigning O36.80X0 be appropriate? I am coding the radiology reports.

Impression 1 - No definite intrauterine pregnancy seen. Differential considerations include early pregnancy, abortion, ectopic pregnancy.

Impression 2 - No sign of a fetal pole or yolk sac within the uterus. Tiny amount of fluid in the uterus may represent a pseudo-sac, very early intrauterine gestation or spontaneous abortion. Since no definite intrauterine gestation is seen ectopic pregnancy is not excluded. Clinical correlation and follow-up recommended.

Thank you for any input.

Julie Davenport, CPC

 

[thomas7331]

If the impression reads the following (2 different scenarios), would assigning O36.80X0 be appropriate? I am coding the radiology reports.

Impression 1 - No definite intrauterine pregnancy seen. Differential considerations include early pregnancy, abortion, ectopic pregnancy.

Impression 2 - No sign of a fetal pole or yolk sac within the uterus. Tiny amount of fluid in the uterus may represent a pseudo-sac, very early intrauterine gestation or spontaneous abortion. Since no definite intrauterine gestation is seen ectopic pregnancy is not excluded. Clinical correlation and follow-up recommended.

Thank you for any input.

Julie Davenport, CPC

Both of these impressions have only negative or inconclusive results, so I would not assign a code based on either of these and would use the indication for the test instead. According to the ICD-10 Chapter guidelines, "Codes from categories O35, Maternal care for known or suspected fetal abnormality and damage, and O36, Maternal care for other fetal problems, are assigned only when the fetal condition is actually responsible for modifying the management of the mother, i.e., by requiring diagnostic studies, additional observation, special care, or termination of pregnancy. The fact that the fetal condition exists does not justify assigning a code from this series to the mother’s record." Based on this, my interpretation would be that the O36 codes should not be assigned based on radiology results that have not yet been integrated into the mother's care plan.

 

[Bready]

inclusive fetal viability, O36.80X0

The reason for the 76817 should guide your coding. The reason was to find out if she was really pregnant. Cannot use any of the impressions as none are a definitive diagnosis. The short answer is she was not pregnant for whatever reason at the time of the ultrasound. I would use code Z32.02 unless the physician can state it was something else.