Ultrasound

  • 1.  76805 vs 76811 for Obesity

    Posted 09-29-2022 14:58
    All,
    Interested in what type of anatomy US (76805 vs 76811) others perform around the country across different classes of obesity.
    Please reply in the following format with the anatomy exam you perform:
    Class I Obesity (BMI 30-34.9):   76805 vs 76811
    Class II Obesity (BMI 35-39.9):  76805 vs 76811
    Class III Obesity (BMI 40+):       76805 vs 76811

    Lastly, if you have any documentation from your payors regarding Obesity and 76811 agreements, please send to me directly. Thanks so much for your time.

    -Blake Porter, MD



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    Blake Porter
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  • 2.  RE: 76805 vs 76811 for Obesity

    Posted 09-29-2022 17:53
    Hi Blake,
    BMI > 30 is an indication for 76811. This is per the consensus among national societies and the corresponding ICD-10 list generated based on the consensus. These include ICD-10 range Z68.30-Z68.45 (Body mass index 30–70 kg/m2, adult). Payers, for the most part, support that or at least should. For example, here is Aetna's website: https://www.aetna.com/cpb/medical/data/100_199/0199.html

    References:
    • Consensus report on the 76811 scan: modification. J Ultrasound Med 2015; 34:1915.
    • Bsat F. Detailed Fetal Anatomic Ultrasound Examination (76811): Updated ICD-10 Indications. J Ultrasound Med. 2022 Apr;41(4):1035-1036. doi: 10.1002/jum.15779. Epub 2021 Jul 7. PMID: 34232530.

    Best,
    Fadi

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    Fadi BSAT, MD, FAIUM
    Chair, SMFM Practice Management Committee
    Immediate past Chair, SMFM Coding Committee
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    Original Message