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Pregnancy Confirmation Visits with ultrasound

  1. #1
    Default Pregnancy Confirmation Visits with ultrasound
    Medical Coding Books

    When we bill dx code v72.42 and an E/M visit for a pregnancy confirmation visit along with ultrasound (76817) the ultrasound is being denied as part of the global and now UHC is also denying the pregnancy confirmation visit (even though the policy clearing states that the confirmation visit is not considered part of the global and is reimbursed separately) when an ultrasound 76817 is billed with it, UHC is stating we need a modifier -25 on the visit. But, when we bill the confirmation visit and ultrasound cpt 76830 they pay without a problem. Which ultrasound code should we bill with the E/M if the patient comes in for missed cycle(s) and we confirm a pregnancy?


  2. #2
    We bill an E/M visit, i.e. 99212-25 with dx of skipped menses and 76830 for the ultrasound with dx of V72.42. 76817 would indicate that you already knew the patient was pregnant. We don't start a prenatal record at that visit and we don't have a problem getting paid.

  3. #3
    Greeley, Colorado
    I would like to hear other thoughts on the ultrasound issue. We use 76817 because what we are actually imaging is a "pregnant uterus". We don't base it on knowing or not knowing if a pregnancy exists.

    I know UHC is difficult. You will probably have to appeal showing that the pregnancy flow sheet had not been started. Basically it seems like a game between providers and carriers.

    As it is right now...we code the E/M with mod -25 and 76817 with dx V72.42. So far no problems...
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Kansas City, MO
    I can't find the document, but ACOG came out some time ago and recommended that anytime an E/M is performed with an Ultrasound the modifier 25 should be attached to the E/M. Now, I know that when it comes to UHC's OB policies, they tend to quote and reference information from ACOG a lot. So, yes, I would add the 25 to the E/M.

    As for ultrasounds, all of my offices are different. The few offices that I have that will bill a Sono at the confirmatory visit do it because the patient can't remember their LMP.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

  5. Default
    We bill with an office visit with -25, and use a GYN ultra sound for missed period, because we do not know if they are pregnant or not until we actually provide the ultra sound. We have no problems.

  6. #6
    Red face OB confirmation and tests
    I am an RN and a CPC. I am having a hard time with this issue. We have a doctor who performs a high level E/M code with dx absence of menstruation. In addition, she performs a pregnancy test and a transvaginal ultrasound 76830. One issue I have is reguarding diagnosis coding guidelines. A diagnosis by a physician is to be what the doctor knows by the end of the visit. So if a patient comes in for a pregnancy test, has a physical exam, shouldn't the diagnosis be pregnancy? For example: a patient who comes in with a sore throat. If a strep culture was positive the dx would be for strep. If it was negative the diagnosis would be sore throat. Also, I have a problem with a physician doing pregnancy tests, us, and ob confirmation routinely on patients who are 15-27 weeks gestation and then doing the OB intake visit within a week of this visit. Many patients are far enough along and come in because they are pregnant. Can a doctor get away with doing a confirmation despite being 4-5 months along? I can undertand if it is documented that the patient is not sure about pregnancy. I also have a problem with routine scan on every ob confirmation and then again one week later at the ob intake exam.

    Thanks so much! Deborah

  7. Default
    We Also do E&M and mod 25 //76830// and sometimes a preg test w/ dx for abs of menstr. Worked fine so far on most of our carriers including UHC.
    Now our policy ussually RTO in 2 wks for 1st OB. But that applies only for ptn. under 14 wks. If the ptn is over 14 wks. my doctor will open OB chart right away w/out the conf. visit.

  8. Default
    I have this same question from what i'm understanding the E/M with the 25mod with US code 76830 with dx 626.0 & V72.4x is the best way to go for commerical insurance billing.. Coding the US at the preg confirm visit does not make the US at the inital global?

    Has anyone seen anything different for FL Medicaid?

  9. #9
    Bangor, Maine
    We use V72.42 with an E/M code, -25 modifier, and 76817 because we code FINDINGS, if no findings then we code for symptoms. At the end of the ultrasound we know the pt is pregnant so we code as such.
    Devon Crossman, CPC
    Billing and Coding Specialist, Bangor OB/GYN

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