Pregnancy Ultrasounds

Lately we've been getting quite a few denials from BCBS on our ultrasounds. BCBS will only reimburse 1 pregnancy ultrasound per nine month period. I work at a Fertility clinic so a lot of our patients will have a positive HCG but their ultrasounds do not show an intrauterine pregnancy. We usually bill 76830 if there is no fetus/heartbeat/fetal pole seen on ultrasound. Should we be billing a 76817 since their +HCG indicates pregnancy?

re: Pregnancy Ultrasounds

re: Pregnancy Ultrasounds

what icd-9 code are you using? Most plans limit the number of u/s they will pay for unless medically necessary and then they have to be authorized. If the HCG is positive but the u/s doesn't show anything, are u using V72.40 as your diagnosis?
I would use 76830 if not yet confirmed.

re: Pregnancy Ultrasounds

After our patients undergo infertility treatment they come in for about 3 HCG tests and then 1 ultrasound before they are discharged to their OB, if the ultrasound is abnormal and medically necessary our physicians order a 2nd or 3rd ultrasound. These ultrasounds are done anywhere from 5 to 7 weeks. We typically use dx V230 when it is a normal ultrasound. When the ultrasound doesnt show a gestational sac/fetal pole we have been using 76830 and using a medically necessary ICD-9 (Ex 631.8 - Blighted ovum, 632 Missed Abortion, 634 series, spontaneous abortion, etc). Blue Cross is just giving us a hard time with paying multiple ultrasounds, we also have to be careful how we code because our Blue Cross patients are in a global after their treatment.

re: Pregnancy Ultrasounds

are you getting those after the inital u/s authorized 1st? I am in an OB office and I know that especially with the HMO plan, the u/s are bundled with the global after the first two. After that, we must obtain prior auth to show medical necessity.

re: Pregnancy Ultrasounds

If at the initial ultrasound there is no fetus/fetal pole/heartbeat I'm not sure if I should be coding a 76817 or 76830. The patient has a postive BHCG @ the first ultrasound so we are looking for a pregnancy. Also our billing is a little bit different because we are not an OB and our ultrasounds are not included in the maternity global.

re: Pregnancy Ultrasounds

Yes, but you cant bill a non-ob procedure with a "maternity" or "pregnancy" diagnosis. Insurance usually kicks these out for compatibility issues. So you may want to use the V72.40. Good Luck