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Posted By Christie on 08-09-2006, 20:28:00 in Radiology
Hello List,

Healthcare Partners, HMO Group denied paying 76700. This patient was seen in ER with fever, abdominal & pelvic pain. CPT 76775 was performed first. Report was negative findings.

Then CPT 76700 performed. Report was negative findings.

Then CPT 76801, however, report states positive pregnancy test, no intrauterine pregnancy is seen.

What I correct to code 76801 or should I have coded 76856?
I want to know how I should have properly coded this and if I can get paid for all of them.

76700
76801
76775-59
0r
76700
76856
76775-59
I appreciate all of your help before appealing this claim.
Comments (8)
Posted By Karen on 08-11-2006, 00:16:00
I agree with Stacie, if there was a confirmed pregnancy prior to the
ultrasound an OB ultrasound should be coded.



Karen Cole, RHIT, CCS-P, CPC-H, CGCS
Coding Quality Auditor, Outpatient Services
PHNS, The Detroit Medical Center
Office: 313-993-0347
Mobile: 313-218-0086
Fax: 313-993-2568
Email: Karen.Cole@phns.com or KCole2@dmc.org

Proprietary and Confidential
For PHNS HIM Use Only. (c)PHNS 2003
Posted By STACIE on 08-10-2006, 17:03:00
If the patient was pregnant or there was a positive pregnancy test prior to the US an OB US should
be coded.

Stacie L. Buck, RHIA, CCS-P, LHRM, RCC
Vice President, Southeast Radiology Management

Phone (772) 600-0324
Fax (772) 600-0327

Southeast Radiology Management - www.seradmgt.com
The Medical Billing Company - www.themedbillco.com
Posted By Christie on 08-10-2006, 15:21:00
Stacie,

Since no interuterine pregnancy was seen are you saying to code 76700,76856,76775 OR 76700, 76856 only. Thanks

Also, we get CCI Edits from Ingenix Company, but I want to have NCCI Edits. Is there a site on the internet or whom can I order from for next year?

Thanks for all your input always.
Posted By Christie on 08-10-2006, 15:13:00
Some US is so confusing when the insurance company wants to deny a code and then you start to second guess yourself if you are even allowed to bill 3 US together. Thanks for your help.
Posted By Christie on 08-10-2006, 15:11:00
Thanks Sarah for taking time to help me.
Posted By Christie on 08-10-2006, 15:10:00
Thanks for your help.
Posted By STACIE on 08-10-2006, 11:14:00
Here are some points summarized from CPT Assistant October 2001:



Patient presents with an established diagnosis of pregnancy and signs and symptoms that could be
pregnancy related

* Report the OB US code (76805-76815)

* Outcome that patient is not pregnant or has an US diagnosis that might not be related to
pregnancy (eg, acute appendicitis, torsed ovary, necrotic fibroid).

* Report the OB US code (76805-76815)



Patient presents without an established diagnosis of pregnancy presents with gynecological problems
necessitating ultrasound evaluation (eg, dysmenorrhea, oligomenorrhea, menstrual irregularity,
pelvic pain)

* Report code 76856 or 76857.

* Use of these codes whether or not the outcome of the US is the diagnosis of pregnancy or a
complication related to a pregnancy.



Decision to order and perform an abdominal US is based on indications independent of the state of
the patient's pregnancy status, even if the abdominal complication of a pregnancy is suspected (eg,
pyelonephritis secondary to ureteral obstruction by a pregnancy or suspected cholecystitis in a
pregnant patient with right upper quadrant pain).

The abdominal ultrasound codes 76700, 76705 should be reported for an ultrasound of the abdomen when
signs and symptoms indicate the necessity of an abdominal ultrasound procedure.



Stacie L. Buck, RHIA, CCS-P, LHRM, RCC

Vice President, Southeast Radiology Management



Phone (772) 600-0324

Fax (772) 600-0327



Southeast Radiology Management - www.seradmgt.com

The Medical Billing Company - www.themedbillco.com
Posted By Sarah on 08-10-2006, 09:44:00
I would code the 76700 and 76775 with your abdominal and pelvic pain.
I would code a 76801 because you did have a positive pregnancy test. The docs did the work thinking she was pregnant, what if she is to early to confirm a pregnancy? And she had the 76801 and they didn't find anything, would you just give it to her for free?
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