Coding

  • 1.  Appropriate code for Amniotic Fluid Index (AFI) for non-IUGR patients

    Posted 06-12-2023 17:18

    Good morning

    In my practice, the question has been raised about billing an Amniotic Fluid Index (AFI) check, for non-IUGR patients.  Real reason will be only to be sure the baby has enough Amniotic Fluid between 35 and 38 weeks of pregnancy.  The doctor have ordered 76815, 76819 and NST together, which for me is way too much.  So, what will be the appropriate code to order in this case, if so; as it is also a concern the real necessity of these tests for a non-IUGR patient.

    Thank you very much for the time and help. 

    Henry



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    Henry Gutierrez
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  • 2.  RE: Appropriate code for Amniotic Fluid Index (AFI) for non-IUGR patients

    Posted 06-14-2023 08:11

    Hi Henry,

    The appropriate CPT code for AFI check when an indication exists would be 76815 (limited). Routinely checking AFI between 35 and 38 weeks on all patients is not a guideline-driven indication.

    Fadi



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    Fadi BSAT, MD, FAIUM
    Chair, SMFM Practice Management Committee
    Past Chair, SMFM Coding Committee
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  • 3.  RE: Appropriate code for Amniotic Fluid Index (AFI) for non-IUGR patients

    Posted 06-14-2023 11:47

    Hi Henry,

    I agree that the appropriate CPT code for a limited ultrasound for AFI only is 76815 - when the appropriate indication (ICD 10) exists.

    76815- Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., Fetal heartbeat, placental location, fetal position and/or qualitative amniotic fluid volume),1 or more fetuses

    Thank you very much for your question. Please let us know if you may have any follow up questions. 

    Steve
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    Steve Rad, MD
    Chair, SMFM Coding Committee



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    Steve Rad
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