Coding

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MFM Consultation Coding

  • 1.  MFM Consultation Coding

    Posted 01-13-2020 10:16
    A patient was sent to a MFM for a consultation due to diabetes and it was determined that this MFM would assume the prenatal care for this pregnancy.  After MFM has established care, the patient comes in for prenatal appointment with MFM and a growth ultrasound.  A new fetal abnormality is found on the ultrasound.  Can this MFM perform a second consultation due to the new problem that was found on the ultrasound?

    Example of billing would be:
    1. Prenatal visit with diabetes diagnosis
    2. Ultrasound with new problem diagnosis and growth
    3. Consultation with new problem diagnosis

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    Tamra Davis
    Physician Coding Supervisor
    UF Health OB/GYN Shands
    Gainesville, Fl
    352-273-7582
    Tamra
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  • 2.  RE: MFM Consultation Coding

    Posted 01-13-2020 17:50
    I would say that once an MFM has taken on the care of a patient, you can't do another consult. You cannot consult yourself (or your partner) for an issue. You need a referring doc that has sent a patient to you to ask a question. 

    I believe that had the MFM done a consult on someone, then sent them back to the original OB without taking on the care, and then another issue came up like this, then if the referring doc had sent the patient for an ultrasound and a request for a consult for any abnormal findings, then you might be able to do that, although some insurer's might still say you had a prior encounter with the patient and try to claim outpatient follow-up E&M. But once you take the patient on as the primary provider, I don't see how the regs allow another consult.

    Now if you are actually billing a global for the patient for the global OB care, you could justify an additional E&M for the separately identifiable E&M at the prenatal visit for managing the pre-pregnancy condition of diabetes with the -25 modifier (every time you are actually managing it). We do that frequently at an institution that is very conservative with its billing/coding. You can get the US charge, just not an extra E&M for the poor fetal growth.




    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: MFM Consultation Coding

    Posted 01-13-2020 21:59
    The MFM cannot perform a consultation on his/her own patient. A 76811 can be performed given the finding of abnormality, unless the same MFM physician or group has done a 76811 earlier in the pregnancy. In the latter scenario, a follow-up 76816 should be done. Billing should be:
    1. Prenatal visit with diabetes diagnosis
    2. Ultrasound with new problem diagnosis and growth 76816 (or 76811 if a detailed fetal anatomy survey was not previously performed by the same physician/group)
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    Fadi Bsat, MD
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  • 4.  RE: MFM Consultation Coding

    Posted 01-14-2020 08:22
    You can't do a new consult for the new problem if you have taken over her full care for delivery.

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    Jolene Reeves
    JoleneReeves
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  • 5.  RE: MFM Consultation Coding

    Posted 01-14-2020 09:52
    ​I believe the answer is yes, since the consultation is for a new indication.

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    Wiliam Curtin MD
    Associate Professor of Obstetrics & Gynecology and Pathology
    Pennstate Milton S Hershey Medical Center
    Hershey, PA
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  • 6.  RE: MFM Consultation Coding

    Posted 01-14-2020 09:59
    ​Apologies, I didn't see the part where the patient had already established care with the MFM. In this circumstance, a consult would not be appropriate.

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    Wiliam Curtin MD
    Associate Professor of Obstetrics & Gynecology and Pathology
    Pennstate Milton S Hershey Medical Center
    Hershey, PA
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  • 7.  RE: MFM Consultation Coding

    Posted 01-15-2020 08:43
    As Fadi noted, agree!

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    Vanita Jain
    Vanita
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