• 1.  basic anatomy 76805

    Posted 07-16-2021 13:38
    just want to clarify on billing for routine anatomy scan for normal pregnancy without any current or history of high risk condition. Have been coding Z36.89, Z36.3 for 76805. MFM wants to use O35.8XX0 for all routine 76805's. Is it correct?

  • 2.  RE: basic anatomy 76805

    Posted 07-16-2021 17:37

    I think since 76805 are generally for screening, the appropriate codes are the screening codes. You could add a secondary diagnosis (eg, AMA, obesity, etc) if appropriate, but they are screening and so I can't see point in using a known/suspected anomaly code when there really isn't one. That is what our office does without any issues.

    Best regards,

    David C Jones, MD
    Director, University of Vermont Medical Center Fetal Diagnostic Center
    Professor, Obstetrics, Gynecology & Reproductive Sciences
    University of Vermont
    Dept of Obstetrics, Gynecology & Reproductive Sciences
    Division of Maternal-Fetal Medicine
    (802) 847-5698

  • 3.  RE: basic anatomy 76805

    Posted 07-19-2021 08:39
    Hi David,
    If AMA or obesity are present, these would be indications for a detailed fetal anatomy survey 76811 (per national guidelines).

    Fadi BSAT, MD
    Past Chair, SMFM Coding Committee

  • 4.  RE: basic anatomy 76805

    Posted 07-20-2021 08:41
    Absolutely. We see AMA, BMI > 30 and so on patients all the time who could get a 76811 based on the indication, but since their referring physician/midwife didn’t order that scan, our practice has always felt reluctant “upgrading” the scan and doing something that wasn’t ordered, except in cases where we see an anomaly. I know some practices routinely bump up scans that can be bumped up, but we have not taken that path for a variety of reasons.

  • 5.  RE: basic anatomy 76805

    Posted 07-16-2021 18:56
    Hi Rachel,
    • Z36.3 (Encounter for antenatal screening for malformations) is the appropriate ICD-10 to use with 76805.
    • O35.8XX0 (Maternal care for other (suspected) fetal abnormality and damage, not applicable or unspecified) is an indication to use 76811. It would not be the correct code for routine 76805.

    Fadi BSAT, MD
    Past Chair, SMFM Coding Committee