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E/M codes and Diagnosis for new pregnant patient

Rosi Posted Thu 20th of May, 2010 19:07:22 PM

A patient comes in suspecting she is pregnant, the doctor does a an examination, an uhcg and an ultrasound to dedect the heartbeat only, what are the correct codes for E/M and procedures and the diagnosis?
Thanks

SuperCoder Answered Fri 21st of May, 2010 07:30:01 AM

Since the patient is suspecting pregnancy so in this case you can report ICD V72.40 (Pregnancy examination or test, pregnancy unconfirmed)For UHcG you can use either 84702 or 84703 (For urine preg test by visual color use 81025).
Since the patient is not confirmed as pregnent so you can use 76857 (Ultrasound, pelvic limited). And as per the fulfilments of the E/M components, old vs new pateint you can code 99201-99215 along with a 25 modifier.

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