yeah I mean we do a dating and viability ultrasound on every patient who didn't come from fertility, and use the z36.87. I've never used the O36.80x0 code, unless they do the viability ultrasound and they have to have a f/u in 10 days because its probably going to be a miscarriage. We are doing the ultrasound for screening purposes, but the patient is advanced maternal age.
If it an initial screening I would use z36.87 rather than the AMA Dx as this is the primary reason for the scan on all patients. If the scan is only done on high risk patients, then you would choose the Dx that matches that diagnosis. I would not use O36.80 unless they are trying to rule out miscarriage.
thank you-- i submitted the question to ACOG and they said the same. Since the reason for the visit is for dating and viability that dx code should be listed first then AMA.
Certainly being over 35 may increase a pregnant woman's risk of a possible complication, but it is only about 20% of women in this age range that end up with problems. It is a statement, not an indication that the entire pregnancy would be high risk and require significant additional monitoring. I have always considered the use of this code as secondary and only in cases when the purpose of the testing or extra monitoring is the direct result of a problem that has occurred.