Wiki Missed Anatomy

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hgonzales

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What diagnosis for ICD 10 do you use for an Ultrasound that is being done for the second time at another date due to not seeing all the anatomy the first time. The diagnosis the physician gives us is missed anatomy but I can't seem to find anything with that. Please advise.

Thank you
Hilda G
 
This is not a diagnosis - the diagnosis needs to reflect the patient's condition or symptom that is requiring the test, not the reason that the test is being repeated. If that is not available in the documentation, then you would need to query the physician for clarification.
 
I did query the physician and she said they didn't get a view of certain parts of the anatomy from prior ultrasound that was billed with Z36. Reason was the mother was very overweight and tried the ultrasound on another day to complete the anatomy parts that were not viewed the first time. Will the insurance reject the claim as a duplicate since we can only bill the anatomy once?
Thank you,
Hilda
 
If the test was being repeated due to an error by the technician in performing the procedure, then it wouldn't be appropriate to bill a second time, but in this case it sounds like it's due to a limitation caused by the patient's condition. If the reason for the test is still the same as it was the first time, then in my opinion it has to be billed with the same diagnosis code. You might reach out to the insurance company to see if they have any submission guidelines for this particular situation to avoid a denial, though I think that is unlikely. It is possible that it will be denied for exceeding the number allowed, but I would think that it could easily be appealed with documentation supporting the fact that the repeat test was necessary.
 
We experience this quite frequently in our OBGYN practice. Maybe the baby is in the wrong position or not developed enough or more frequently "due to body habitus" of mother as in your case. We have them return in a few weeks and I bill out 76816 CPT with diagnosis Z03.9. It gets paid consistently.

Kari Johnson, CPC
 
missed anatomy

Thank you so much, I will definitely try this because we get this quite often.

Hilda Gonzales
 
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