Coding

Please post potential questions for the SMFM PM Webinar on June 18, 2019, at 1:00 PM EST.
The panel will attempt to address as many of the submitted questions as possible.

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Thomas Lee MD, MBA
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1. Should you bill for a 76801 with the NT 76813?
2. What is the best way to bill for a 15 week scan?

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Kelly Gibson
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Original Message:
Sent: 06-11-2019 10:16
From: Thomas Lee
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Please post potential questions for the SMFM PM Webinar on June 18, 2019, at 1:00 PM EST.
The panel will attempt to address as many of the submitted questions as possible.

------------------------------
Thomas Lee MD, MBA
------------------------------

Hi Kelly
Thanks for your question, we had planned to get to question #1 at least during the webinar yesterday, but as you know time ran out.  In brief
1) Each test - your 76801 and your 76813 would have to have their own distinct indication.  Then yes, if you have an indication to perform each test, they can be performed at the same time.  As this is a common question that is actually more complex then one would initially think (given all the scenarios) we have a whole white paper on this topic. If you go to our website and access "white papers" its the 3rd one down (from 2017) where we address all the variety of 76801/76817/76813 scenarios we could come up with! ​
2) I believe we answered this during the webinar, with some interesting discussion!
Thanks
Vanita

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Vanita Jain, MD
SMFM Coding Committee Chair
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Original Message:
Sent: 06-12-2019 09:45
From: Kelly Gibson
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

1. Should you bill for a 76801 with the NT 76813?
2. What is the best way to bill for a 15 week scan?

------------------------------
Kelly Gibson

Original Message:
Sent: 06-11-2019 10:16
From: Thomas Lee
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Please post potential questions for the SMFM PM Webinar on June 18, 2019, at 1:00 PM EST.
The panel will attempt to address as many of the submitted questions as possible.

------------------------------
Thomas Lee MD, MBA
------------------------------

How should triplet and quadruplet ultrasounds be coded?
For example, if pt comes in for a follow up ultrasound in her 2nd trimester, cpt 76816.

Thank you.

------------------------------
Ying Chan, MD
------------------------------

Original Message:
Sent: 06-11-2019 10:16
From: Thomas Lee
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Please post potential questions for the SMFM PM Webinar on June 18, 2019, at 1:00 PM EST.
The panel will attempt to address as many of the submitted questions as possible.

------------------------------
Thomas Lee MD, MBA
------------------------------

It actually depends on the carrier.  Some carriers are fine with you billing 76816 with ) units and others want you to do it line by line, using the -59 modifier on the subsequent ultrasounds.  Be sure your #1 ICD-10 is your multiple code (i.e. twins/triplets/quadruplets). ​ United Healthcare is one who requires you bill it on separate lines.

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Jolene Reeves, CCS-P

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Original Message:
Sent: 06-14-2019 09:51
From: Ying Chan
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

How should triplet and quadruplet ultrasounds be coded?
For example, if pt comes in for a follow up ultrasound in her 2nd trimester, cpt 76816.

Thank you.

------------------------------
Ying Chan, MD

Original Message:
Sent: 06-11-2019 10:16
From: Thomas Lee
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Please post potential questions for the SMFM PM Webinar on June 18, 2019, at 1:00 PM EST.
The panel will attempt to address as many of the submitted questions as possible.

------------------------------
Thomas Lee MD, MBA
------------------------------

Hi Ying
Thanks for your question.  I was hoping to get to multiples yesterday during the webinar, but unfortunately we did not have time! If you go to our website and search under Questions and Answers utilizing the search term quadruplets, you will see we have answered this question in the past.  Multiples are the most common reason for Modifiers and this is a great question because there are 2 option for the modifier selection.  I have copied the answer the committee has given in the past: 

Answer:

------------------------------
Vanita Jain, MD
SMFM Coding Committee Chair
------------------------------

Original Message:
Sent: 06-14-2019 09:51
From: Ying Chan
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

How should triplet and quadruplet ultrasounds be coded?
For example, if pt comes in for a follow up ultrasound in her 2nd trimester, cpt 76816.

Thank you.

------------------------------
Ying Chan, MD

Original Message:
Sent: 06-11-2019 10:16
From: Thomas Lee
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Please post potential questions for the SMFM PM Webinar on June 18, 2019, at 1:00 PM EST.
The panel will attempt to address as many of the submitted questions as possible.

------------------------------
Thomas Lee MD, MBA
------------------------------

As far as which criteria to use in the coding for obesity.
Is there any reason why one shouldn't use the same rationale used for AMA since obesity is just as well defined ie BMI > 30 ? 

The question that remains in my mind is whether prepregnancy weight is the most optimal piece of information that should be utilized?

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Myriam Mondestin-Sorrentino
------------------------------

Original Message:
Sent: 06-19-2019 04:53
From: Vanita Jain
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Hi Ying
Thanks for your question.  I was hoping to get to multiples yesterday during the webinar, but unfortunately we did not have time! If you go to our website and search under Questions and Answers utilizing the search term quadruplets, you will see we have answered this question in the past.  Multiples are the most common reason for Modifiers and this is a great question because there are 2 option for the modifier selection.  I have copied the answer the committee has given in the past:

How do I code for a first trimester scan for quadruplets? Is the 59 modifier necessary? i.e. 76801 76802 76802-59 76802-59 Thank you 

Answer:

You can either use the CPT as you noted, or if your insurer uses the EPSU modifiers, bill with one of the 2 following method

76801, 76802, 76802-XS, 76802-XS or

76801, 76802, 76802 X2 (the method of coding depends on carrier preference)

It is important to check payer policies, and to stay updated on insurers who are recognizing these new modifiers.

Note: the 59 and EPSU modifiers should not be used simultaneously.

------------------------------
Vanita Jain, MD
SMFM Coding Committee Chair

Original Message:
Sent: 06-14-2019 09:51
From: Ying Chan
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

How should triplet and quadruplet ultrasounds be coded?
For example, if pt comes in for a follow up ultrasound in her 2nd trimester, cpt 76816.

Thank you.

------------------------------
Ying Chan, MD

Original Message:
Sent: 06-11-2019 10:16
From: Thomas Lee
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Please post potential questions for the SMFM PM Webinar on June 18, 2019, at 1:00 PM EST.
The panel will attempt to address as many of the submitted questions as possible.

------------------------------
Thomas Lee MD, MBA
------------------------------

Hi Myriam,
I am assuming you are referring to obesity as indication for 76811. Yes, the guidelines state BMI > 30 is an indication for 76811. One should use pre-pregnancy weight if available, otherwise the BMI would calculated at the first encounter that pregnancy.

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Fadi Bsat
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Original Message:
Sent: 06-20-2019 08:37
From: Myriam Mondestin-Sorrentino
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

As far as which criteria to use in the coding for obesity.
Is there any reason why one shouldn't use the same rationale used for AMA since obesity is just as well defined ie BMI > 30 ?

The question that remains in my mind is whether prepregnancy weight is the most optimal piece of information that should be utilized?

------------------------------
Myriam Mondestin-Sorrentino

Original Message:
Sent: 06-19-2019 04:53
From: Vanita Jain
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Hi Ying
Thanks for your question.  I was hoping to get to multiples yesterday during the webinar, but unfortunately we did not have time! If you go to our website and search under Questions and Answers utilizing the search term quadruplets, you will see we have answered this question in the past.  Multiples are the most common reason for Modifiers and this is a great question because there are 2 option for the modifier selection.  I have copied the answer the committee has given in the past:

How do I code for a first trimester scan for quadruplets? Is the 59 modifier necessary? i.e. 76801 76802 76802-59 76802-59 Thank you 

Answer:

You can either use the CPT as you noted, or if your insurer uses the EPSU modifiers, bill with one of the 2 following method

76801, 76802, 76802-XS, 76802-XS or

76801, 76802, 76802 X2 (the method of coding depends on carrier preference)

It is important to check payer policies, and to stay updated on insurers who are recognizing these new modifiers.

Note: the 59 and EPSU modifiers should not be used simultaneously.

------------------------------
Vanita Jain, MD
SMFM Coding Committee Chair

Original Message:
Sent: 06-14-2019 09:51
From: Ying Chan
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

How should triplet and quadruplet ultrasounds be coded?
For example, if pt comes in for a follow up ultrasound in her 2nd trimester, cpt 76816.

Thank you.

------------------------------
Ying Chan, MD

Original Message:
Sent: 06-11-2019 10:16
From: Thomas Lee
Subject: Questions for PM Webinar on Common Ultrasound Coding Mistakes (June 18, 2019 at 1 PM EST)

Please post potential questions for the SMFM PM Webinar on June 18, 2019, at 1:00 PM EST.
The panel will attempt to address as many of the submitted questions as possible.

------------------------------
Thomas Lee MD, MBA
------------------------------