Coding

  • 1.  Coding Questions

    Posted 07-25-2019 08:26
    Good Morning
    I thought it might be useful to post some of our coding Q&A's here on this forum, in addition to their formal posting on the SMFM Website under coding resources, as each of us has our preferred social media/web interaction.  We get about 10-12 questions/month, I am selecting a few from July that I feel come up often at the courses too.  This way more of the membership will have access to this information:

    Coding Q&A: Question #1951

    If a patient is sent for a suspected anomaly from and outside ultrasound, but you do not find it on yours - do you bill a 76811 or an 76805? and do you use the Z code for not found or the O code for suspected? Thanks

    Answer:

    As the patient is referred to your MFM practice to confirm/refute the anomaly visualized on outside ultrasound, we recommend utilizing the O35.- series as the indication for performing the anatomy evaluation.  This clinical scenario would also support performance of a 76811.  The SMFM listing of recommended indication codes for performance of a 76811 can be found at this link:  https://onlinelibrary.wiley.com/doi/epdf/10.7863/ultra.16.01036.

    Coding Q&A: Question #1950

    How do you bill an amnio dye test performed when the abdomen is prepped with betadine, a 20g needle is inserted into the uterus under ultrasound guidance and 5ml of fluorescein was injected into the amniotic space?

    Answer:

    This service is reported with CPT code 59070  Transabdominal amnioinfusion, including ultrasound guidance.

    Coding Q&A: Question #1945

    What is the correct diagnosis for Anyhydramnios? Some say oligo should be used but we do not agree with that diagnosis?

    Answer:

    The ICD-10-CM alphabetic index indicates that the appropriate code for anhydrdamnios is O41.8X--  Other specified disorders of amniotic fluid and membranes, ________ trimester.  The sixth character reflects the trimester and the 7th character reflects the fetus affected.

    Coding Q&A: Question #1947

    Can Z36.4 be used for serial growth scans? The description of the code states screening for IUGR. We used Z36.4 after the IUGR resolves when the patient continues to be surveillanced thereafter. Is Z36.4 only billable in this scenario? Please provide other scenarios when Z36.4 can be used?

    Answer:

    Z36.4 is an appropriate diagnosis for this circumstance.  If a patient has confirmed IUGR in the current encounter, you would report a diagnosis from the O36.5- category.  If you have clinical concerns about IUGR, but it is not confirmed by the ultrasound, you would report Z03.74  Encounter for suspected problem with fetal growth ruled out.  There are no other clear scenarios in which the use of Z36.4 is appropriate.  Please note that some insurers may require you to use an O36.5- category code as a payable diagnosis in this situation, even if there is no IUGR, as the condition is "suspected."

    As always, myself or Fadi (past Chair of the Committee), or any of our committee members are available to answer any questions.  You can utilize this forum if you feel comfortable, or you can email any of us privately through communities, the SMFM website, Facebook, or personal emails (vjain@dcmfm.com).  I'll try to post Q&A's on here that come up frequently so that we can get the information out to more members.
    Thanks



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