This is true, you do need medical necessity for billing both codes together if you are doing the 76813 for purposes of NT only. You can do them both at the same visit. As shown in the slides, the most common coding would be for antenatal screening. For example, if a patient has had NIPT done previously, then the NT would not be required for antenatal screening and would not be performed.
Separately, the SMFM coding committee realizes that detailed first trimester ultrasound (DFTU) does not yet have a code and has recommended that 76813 can be billed in that instance with 76801. However DFTU should only be done with specific indications.
https://s3.amazonaws.com/cdn.smfm.org/media/3243/Translated_ICD-10_indications_for_DFTU_12-7-21.pdf------------------------------
Brian Iriye
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Original Message:
Sent: 10-27-2022 14:20
From: Monica Dowdell
Subject: 76813 and 76801
Hi there
Yes this is a combined ultrasound that is routinely done on all patients. We have read that there has to be medical necessity to bill both the 1st check and the NT together. But we are are routinely doing these for each patient that presents. Just wanted to confirm we are able to do these together verses having the the patient return for an NT. This pertaining to slides 25-30
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Monica Dowdell
Original Message:
Sent: 10-19-2022 17:36
From: Brian Iriye
Subject: 76813 and 76801
Monica,
I would request a bit more clarity to your question. Is it the combined ultrasound? Is there problems with denials? These 2 can be billed simultaneously but I would ask for more specificity in the question and we would of course then really like to assist.
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Brian Iriye
Original Message:
Sent: 09-30-2022 10:55
From: Monica Dowdell
Subject: 76813 and 76801
Good morning!
At our facility we perform a NT most commonly during the 1st trimester detailed ultrasound. Charging for 76813 and 76801 (single gestation and then following coding guidelines for twins). To do both at the same time routinely ensures best patient practice. With our patient population some may not return again for either the NT or 1st trimester detailed ultrasound if scheduled separately. Your recommendations are greatly appreciated.
Thank you
Monica
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Monica Dowdell
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