Coding

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Nuchal Translucency

  • 1.  Nuchal Translucency

    Posted 07-13-2020 16:43
    Good afternoon

    When an NT is attempted but could not be visualized. What is the correct way to bill? A 52 modifier or not billing at all

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    Monica Dowdell
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  • 2.  RE: Nuchal Translucency

    Posted 07-13-2020 17:51
    Hello Monica,

    This is a common question received by the coding committee. 76813-52 is NOT recommended because obtaining the NT measurement is essential for that CPT code and the charge will likely be denied with a -52 modifier. In addition, if the patient is brought back few days later and the NT is obtained on the subsequent study, 76813 may be denied (again) since 76813 is typically allowed only once per pregnancy.

    76813 should only be billed if the NT measurement is obtained by either the abdominal or vaginal approach. If the NT measurement could not be obtained, billing options include:
    • 76815 (limited), or
    • 76801 (if an indication exists for a first trimester study)
    Fadi


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    Fadi Bsat, MD
    Past Chair, SMFM Coding Committee
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  • 3.  RE: Nuchal Translucency

    Posted 07-14-2020 05:01
    A few options (depending on TA/TV approach)
    76817 if you attempted TV and document all required components
    76815 (Limited Ultrasound Study)
    76813-52 (Reduced Service)



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    Vanita Jain, MD
    Chair, SMFM Coding Committee
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  • 4.  RE: Nuchal Translucency

    Posted 07-14-2020 10:47
    I should mention, when I replied earlier I meant the order of my preference for billing.  But I don't think that was very clear.
    Fadi and I were discussing this just now and were saying that 76813-52 will likely get denied if you then bring them back for the 76813 in 2-3 days (which I forgot to mention).

    To be clear, consider the order of choices to bill as follows:
    76817 (if you did a TV and got all the components, do NOT bill the 76813 that day)
    76801 (if there is a separate indication to perform this study that day, do NOT bill the 76813 that day)
    76815  (just bill the limited - FHR, placenta, do NOT bill the 76813 that day)
    76813-52 (last resort, high likelihood for denial, not our favorite choice)
    Then you would have the patient return if able to within the GA/CRL window and bill the 76813 when you bring them back in 2-3 days.
    Check with your payer or f/u on your denials to see next steps

    phew! hopefully that's better - goes to show I should stop responding to these emails so early prior to coffee - ha ha!
    have a great day
    v


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    Vanita Jain, MD
    Chair, SMFM Coding Committee
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