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Obstetric Ultrasounds

  1. Default Obstetric Ultrasounds
    Medical Coding Books
    I would love to get some feedback on how other practices are billing for OB ultrasounds. We are encountering more and more denials. Our usual policy is to do the first US at 1st ob visit (6 weeks) and then we do an 18 week scan on all patients. The problem is that some ins companies only pay for 1 per pregnancy and since the 6 week one is billed first they don't pay for the more ceomprehensive one at 18 weeks. It also is a matter of proving medical necessity when there are no abnormal findings. Does anyone make the patient sign an ABN and charge the patient if denied? Thanks very much for any input!

  2. #2
    heres a fun one,
    you are correct, insurance companies usually only pay for one US
    i had it explained to me like this.....
    if the dr wants to do an additional US in the preganacy to make sure "everything is ok" that is the dr's choice but if there is no probelm why should we(the insurance company/patient) have to pay. there is no medical reason(problem) for the test. Exception if the pt is demanding one or just wanting one then a ABN or prepayment is done.
    I didnt like the answer but it does make sense.
    I have the same issue with our ob doctors and i think :-) i finally have made them see the insurances point of view. but i see the dr's side too. sometimes you dont know there is a problem until you do the US. we still bill for everything they do we just have to adjust it off
    good luck
    christine g CPC

  3. Default
    Depending on the insurance company but we have had some luck with our doctors writting a letter to the insurance to explain why a second is done and have gotten paid by doing that.

  4. Default
    First of all, when a patient presents for their first visit, are you doing an ultra sound to "confirm" the pregnancy? When we have a patient presenting for confirmation of pregnancy they are coming because of a missed period 626.8 and we do a GYN ultra sound 76856/or 76830 which confirms the pregnancy with dx's 626.8, V72.42. The OB record has not been started yet (until next visit). The 18-20 week ultra sound will be their first OB ultra sound billed. So 1st visit is billed with an E&M and GYN ultra sound.

  5. Default
    Many times the first ultrasound is done because the pt has had a positive pregnancy test and we are doing the ultrasound because they are unsure of their dates.

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