Hi Brian!
I am not sure if I should say thank you for posting these or not (ha ha!) since these are tough! As you noted definitely challenging billing scenarios ;-). We were hoping to get to these during our Webinar yesterday and unfortunately time ran out. I know you know the answers to these, but some of these questions have come up from other members as well during the survey so for our readers I will respond here.
I have discussed some of these questions ahead of time with Fadi so I will post quick responses here, and then anything that needs a more formal committee response will be posted to our Coding Website. Again - thank you so much for posting these!
a) how do you code mo/di TTTS checks
in general 76816, 76816-XS - but I noticed 2 other members posed this question with some slight variation, so I will submit those to the committee and post as a formal answer
b) how do you code color doppler for checking the placenta flow (PAS)
thanks for asking this! an opportunity for us to highlight that we have an entire white paper on this topic with about 8 different clinical scenarios.
in short there is no color doppler code alone
please see our website
c) Is the ICD-10 code for trimester it was diagnosed or does it change as the patient progressed thru trimesters
Yes, there is a lot of confusion here about what to do when our patients, especially inpatient antepartums go through the weeks during their often lengthy stays. There is a rule for inpatient billing where you code for the trimester they were admitted, and the week they were admitted. The rule that you describe (ICD-10-CM instructions Chapter 15.a.4)) primarily applies to hospital billing and in practice does not necessarily apply to physician services. That rule does not apply to weeks of gestation codes (Z3A.-). However, some payers may have coding edits that prevent a second trimester code being used in conjunction with a third trimester code on the same claim (e.g. O60.02 and Z3A.29). We recommend that you submit the diagnoses required to facilitate appropriate claim payment, regardless of the ICD-10-CM guidelines.
d) do you bill 76813 after a person has NIPT; what if NT is enlarged with normal NIPT?
see white paper on this topic
e) how do you set criteria for billing for obesity
BMI is > 30 is considered an acceptable indication for anatomy evaluation (specifically 76811), however when and how should that BMI be determined. we recommend pre-pregnancy, though the literature quoted in the original 76811 consensus paper is limited about how/why that was chosen, as opposed to the BMI at the time of the scan. there is also significant variance in BMIs reported (vs actually measured) and then when the BMI was obtained. we have addressed this in last months (May) coding tip on the website. the coding committee does not give clinical advice however, so ultimately we defer to other publications about the definition of obesity to determine BMI
f) when doing a f/u 76816 for something like renal tract dilation, do you have to do the biometry measurements again if there is no indication?
76816 Follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan) should be reported accordingly. CPT 76816 should be used for follow-up anatomy &/or follow-up growth when an indication is provided for the follow-up study
I will need to check the CPT description to see if biometry is a required component or not - will post to the website so can be answered formally!
g) does AMA with no testing (hence continued increased risk of chromosome abnormality) allow for fetal echo to assess still increased risk of aneuploidy
I think we answered this during our webinar. the committee does not provide clinical advice - but we can point you in the direction of published guidelines (AIUM, ACC) for indications supporting performance of a fetal echo:
https://www.aium.org/resources/guidelines/fetalEcho.pdfhttps://www.aium.org/resources/guidelines/fetalEcho.pdf
https://www.ahajournals.org/action/cookieAbsent------------------------------
Vanita Jain, MD
SMFM Coding Committee Chair
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Original Message:
Sent: 06-17-2019 22:26
From: Brian Iriye
Subject: Here we go
I am going to add some just to keep this going. I know most of them but know they are difficult so hope they spur conversations. There are a couple I dont know!!
a) how do you code mo/di TTTS checks
b) how do you code color doppler for checking the placenta flow (PAS)
c) Is the ICD-10 code for trimester it was diagnosed or does it change as the patient progressed thru trimesters
d) do you bill 76813 after a person has NIPT; what if NT is enlarged with normal NIPT?
e) how do you set criteria for billing for obesity
f) when doing a f/u 76816 for something like renal tract dilation, do you have to do the biometry measurements again if there is no indication?
g) does AMA with no testing (hence continued increased risk of chromosome abnormality) allow for fetal echo to assess still increased risk of aneuploidy
h) what is the most frequent mistake with ICD 10 coding.
i) tell me one most common misconception with US coding
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Brian Iriye
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