Christina
Thanks for your question.
In general - tobacco use alone would not seem to be an adequate reason for performance of a 76811 (which is really looking for aneuploidy markers). the biologic plausibility of tobacco use causing birth defects - specifically seen on level 2 is questionable. I agree with your sentiment, and would recommend the use of 76805 for this scenario.
In regards to your question about prior c-section. I think many MFMs are concerned here mostly about the prior uterine scar, LUS thickness, and then placentation (abnormal invasion). I understand and have heard at our Coding Courses members ask about utilizing the 76811 to recoup the additional "time" or (work/RVU) involved in evaluating these areas and as such feel 76811 is warranted over 76805. In my personal practice we utilize 76805 for this indication (prior c-section scar only) but Dr. Bsat (the former Coding Chair) and Brad Hart (SMFM Coding specialist) are in this group - so they may have a differing opinion. You are correct prior c-section alone is NOT a listed indication in the paper about 76811, but to be fair, this list was not all inclusive.
Best,
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Vanita Jain, MD
SMFM Coding Committee Chair
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Original Message:
Sent: 07-09-2018 14:29
From: Christina Pisani Conway
Subject: 76811 coding question
Silly question with regard to 76811 coding... reviewing the JUM consensus on 76811 and the ICD10 update in 2016, I don't think maternal smoking or previous cesarean is clearly described by any of the acceptable codes, not do I think about those conditions clearly indicating a level II. My hospital coding team suggested billing a 76811 in the setting of maternal smoking or previous cesarean section, but my feeling is that it's not appropriate. Is this consistent with other's opinions/billing practice? Thank you!
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Christina Pisani Conway
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