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76811 coding question

  • 1.  76811 coding question

    Posted 07-09-2018 14:30
    ​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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  • 2.  RE: 76811 coding question

    Posted 07-10-2018 05:10
    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, 
    Vanita
    SMFM Coding Chair





  • 3.  RE: 76811 coding question

    Posted 07-10-2018 05:11
    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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  • 4.  RE: 76811 coding question

    Posted 07-10-2018 17:18
    You are correct. Smoking and prior C-Section are not by themselves indications for 76811 according to the consensus.

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    Fadi Bsat
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  • 5.  RE: 76811 coding question

    Posted 07-10-2018 22:51
    We have not been using those situations for detailed anatomic survey -- can't see how either significantly increases the risk for fetal malformation. 

    Am interested in other opinions, for sure, but would rather know if anyone can confirm getting paid to do a 76811 scan using these two "indications" ...





  • 6.  RE: 76811 coding question

    Posted 07-11-2018 06:23
    Thanks very much for the confirmation!!

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    Christina Pisani Conway
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  • 7.  RE: 76811 coding question

    Posted 07-11-2018 14:12
    Thanks for bringing your question to the communities page.  Another resource to show your hospital is the Aetna ultrasound guidelines which were developed with the SMFM.  It is located at:  Ultrasound for Pregnancy - Medical Clinical Policy Bulletins | Aetna

    This link contains all the diagnostic codes that are valid for each type of ultrasound.   I think the only one that I know of that is in dispute now is the definition of obesity at BMI of 35 instead of 30.

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    Brian Iriye
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  • 8.  RE: 76811 coding question

    Posted 03-01-2020 10:58
    Hi all - curious whether there is a consensus list of maternal medications that are indications for 76811. Thanks! -Alison

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    Alison Stuebe
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  • 9.  RE: 76811 coding question

    Posted 03-01-2020 19:39
    Not that I know of. But what we've done is that anything that has been implicated as a teratogen, well-curated and annotated, we've used this guideline. With that being said, we've not had any issue when that code is used. Hope this helps. 
    Allan Fisher

    --
    Allan J Fisher, MD, FACOG, FACMG

    "None of us is as dumb as all of us." NASA

    "After this, there is no turning back. You take the blue pill - the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill - you stay in Wonderland, and I show you how deep the rabbit hole goes. Remember: All I'm offering is the truth."
    – Morpheus from The Matrix










  • 10.  RE: 76811 coding question

    Posted 03-01-2020 20:03
    I am not aware of any such list either. There is an ICD 10 for fetal exposure to drugs, O35.5XX0. I think the key word is "exposure" which means any medication in my mind. I don't think it implies there has to be a known teratogen effect.
    Andrea Greiner


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    Andrea Greiner
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  • 11.  RE: 76811 coding question

    Posted 03-02-2020 08:33
    Hi,
    There is no consensus list. However, O35.5XX# refers to "Maternal care for (suspected) damage to fetus by drugs". It is included in the list of ICD-10 codes for which 76811 would be indicated. When used in this context, it implies the drug is known or suspected to cause fetal damage or harm, meaning a teratogen. 76811 should not be performed for "any" fetal drug exposure, but just for those exposures where the fetus was exposed to a known or suspected teratogen.

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    Fadi Bsat, MD
    Past Chair, SMFM Coding Committee
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