I am curious as to why you would use 649.60 rather than the V22.0. These are not equivalent codes at all. The V22.0 is a supervision of a normal first preganancy and 649.60 is other condition of the mothercompliction the pregancy, a uterine size date discrepancy, and then you indicate unspecified as to whether this is during the pregnancy or postpartum etc.
If this is a normal size date check then you use the V22.0, if the payer does not pay then it is probably due to this being global. If there is no problem with the preganancy or the mother then as a coder you are not to diagnose one and code it just to get a claim to pay.
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