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referral, coding and billing for follow-up fetal anatomy surveys

  • 1.  referral, coding and billing for follow-up fetal anatomy surveys

    Posted 02-19-2019 08:50
    I was wondering how others deal with referral,  coding and billing for follow-up fetal anatomy surveys. The situation is a patient comes in for a fetal anatomy survey, either routine screening 76805 or detailed, with appropriate indication,  76811. The anatomy survey is incomplete and we suggest a follow-up to complete. The way our practice has dealt with this is to schedule the follow-up before the patient leaves then ask for the original referring physician to sign off on an order for the follow-up scan. At one time we were coding and billing for the follow-up as a 76816, we recently switched to the code 76815. I am wondering how others handle the situation.
    Bill

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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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  • 2.  RE: referral, coding and billing for follow-up fetal anatomy surveys

    Posted 02-20-2019 08:18
    Hello,
    So you have 2 options for confirming a follow-up request: (1) obtain an order for the follow-up study each time, or (2) have written agreement from your referring providers that a follow-up will be scheduled since the anatomy was not fully documented in the first visit (76811 or 76805). As to how to bill for the follow-up study to complete the fetal anatomy survey, I recommend using 76816, not 76805.

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    Fadi Bsat
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  • 3.  RE: referral, coding and billing for follow-up fetal anatomy surveys

    Posted 02-20-2019 11:56
    ​Thank you Dr. Bsat.
    Bill

    ------------------------------
    Wiliam Curtin MD
    Associate Professor of Obstetrics & Gynecology and Pathology
    Pennstate Milton S Hershey Medical Center
    Hershey, PA
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  • 4.  RE: referral, coding and billing for follow-up fetal anatomy surveys

    Posted 02-21-2019 11:20
    I would use a 76805 or 76811 - as applicable for the initial anatomy scan - I would not use one after the other if this was an early (16 week anatomy) - followed by another detailed anatomy. If this is a follow up due to inability to obtain all images - then the coding depends on what was re-imaged - i.e. I would bill a 76815 if only the very limited missing anatomy component is re-imaged. If a full growth is performed along with follow up anatomy - I would bill a 76816.

    Hope this helps!

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    Niraj Chavan

    Assistant Professor,
    Maternal Fetal Medicine,
    University of Kentucky College of Medicine
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  • 5.  RE: referral, coding and billing for follow-up fetal anatomy surveys

    Posted 02-21-2019 13:02
    Hi Niraj,
    Limited study 76815 is typically reserved for evaluation of one or more of the following: (1) viability, (2) placenta location, (3) amniotic fluid volume, and (4) presentation. The correct billing if the anatomy or part of the anatomy is reevaluated is 76816, wether the fetal growth is obtained or not. If 76815 is used instead of 76816 to bill for fetal anatomy follow-up, it will probably be reimbursed but the SMFM coding committee recommends using 76816 in that situation.
    Thank you,
    Fadi

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    Fadi Bsat
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  • 6.  RE: referral, coding and billing for follow-up fetal anatomy surveys

    Posted 02-21-2019 13:23
    Good to know!!

    Thank you for the follow up!

    Niraj







  • 7.  RE: referral, coding and billing for follow-up fetal anatomy surveys

    Posted 02-20-2019 08:38
    In these scenarios, the follow-up scan is the appropriate code to use. Below is the answer for SMFM coding question #1321, which is archived on the web site. As far as referral for the follow-up ultrasound, although it is typically not a requirement, it's helpful to obtain the referral.
    I hope this helps!

    In situations where all elements are performed but some structures cannot be visualized, the physician is entitled to report and receive the entire reimbursement for procedure. When the structures cannot be visualized, it needs to be clearly noted in the body of the ultrasound report as to why ie: ("Unable to visualize due to early gestational age", "Unable to visualize due to fetal position") etc. in order to bill for 76805 or 76811. If the patient is coming back to complete the anatomy that was not initially seen, a follow-up ultrasound 76816 Follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan) should be reported accordingly. For further clarification, we suggest that you review the SMFM White Paper on the 76811, which can be located on the website.

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    Trisha Malisch, CPC
    Lead Coder, SMFM Coding Committee
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  • 8.  RE: referral, coding and billing for follow-up fetal anatomy surveys

    Posted 02-20-2019 10:55
    ​Thanks you Trisha!
    Bill

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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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