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OB vs Pelvic

George Posted Fri 30th of September, 2016 17:05:42 PM
When a patient comes in for an early OB ultrasound, I use 76801. If the patient has retained products, a blighted ovum, or a missed abortion, should I change the CPT from 76801 to 76856? There is some confusion, because the diagnosis for retained products, blighted ovum, and missed abortion are all OB diagnosis.
SuperCoder Answered Tue 04th of October, 2016 03:10:44 AM

Greetings from SuperCoder!


Since the patient came in for an early OB ultrasound, you need to report OB ultrasound code and should not change your CTP code 76801 to 76856.

As per CPT Assistant (October 2001; Volume 11: Issue 10),

Obstetrical Ultrasound Coding:

To clarify, for female patients with an established diagnosis of pregnancy, determined by any method, and with indications for the ultrasound procedure that might be pregnancy related, it is appropriate to report an obstetrical ultrasound code.

For a patient with an established diagnosis of pregnancy (determined by any means), with signs and symptoms that could be pregnancy related and necessitating an ultrasound evaluation of the pelvis, the obstetrical ultrasound codes should be reported, even if the outcome of the procedure is that the patient is now not pregnant or has an ultrasonic diagnosis that might be construed as being independent of the pregnancy (eg, acute appendicitis, torsed ovary, necrotic fibroid).


Pelvic Ultrasound Coding:

If a female patient without an established diagnosis of pregnancy presents with gynecological problems necessitating ultrasound evaluation (eg, dysmenorrhea, oligomenorrhea, menstrual irregularity, pelvic pain, etc.), then it is appropriate to report a pelvic ultrasound code 76856 or 76857. The use of codes 76856 or 76857 is not predicated upon whether or not the outcome of the ultrasound procedure is the diagnosis of pregnancy or a complication related to a pregnancy.


Please feel free to write if you have any concern/query.



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