Coding

1. Can (or should) an OB/Gyn provider order a Detailed US 76811 by an MFM team, but NOT have a consult? 
2. Some MFM practices allow Detailed US as "scan only" without MFM consult for indications like AMA, BMI or even DC twins and IVF. Can or should that be allowed, or should we say you cannot have a Detailed US without a consult? 
3. If allowed, and there is a finding on a Detailed US scan only (placental, fluid, soft makers, minor or major finding, etc), how should that be handled? 1) Only discuss the findings with the patient (and somehow ignore everything else about their history) which technically is a consult (if you are discussing EIF, CPC, SUA, etc), 2) have an understanding/standing orders with the Ob/Gyn providers and then consult, or 3) let the Ob/Gyn provider discuss the findings (which some would prefer to do, not sure why), and if they choose to send them back for consult, great.
4. Some MFM offices use for orders: 1) "Detailed US, consult as indicated"; or 2) "MFM consult, US as indicated" as the only two orders available. What if a Detailed US is ordered as scan only and specifically NO CONSULT when it is clearly indicated for something else (ie, diabetes, history of PTD, etc)? Do you say we don't do that (or those reasons are indications for consults), and if you want the detailed, you need a consult? Otherwise, they need to do a Complete 76805 scan only?

Hi Peter ~ A quick note that you may also get guidance on the practice management community page if you post over there, too!

~Rachel

Hello,

Since it's a coding thread I will reply from my experience. I code for over 20 mfm practices and many Obgyn practices. I will tell you that a lot of it depends on location. In the south a lot of private mfms also deliver pts so I see way less consults done by mfms. Usually they don't manage pts and just follow obgyns orders. Up North, mfms who don't deliver, they manage pts until they deliver. The relationship between mfms and obgyns are very different in the south. I think it's a matter of relationships between doctors and since mfms rely on referrals from Obgyn it's a thin line that they don't want to cross. I do have mfm practices that still do what they are comfortable with and do consults and manage pts but the referral rate to those mfm offices are way less…. This is just my observation. 

Hi.  We are one of those practices that use 1) "Detailed US, consult as indicated"; or 2) "MFM consult, US as indicated" as our primary ultrasound orders. If there are no risk factors or indications for a consult, none is charged but, when there are risk factors/indications, we will not take on the liability for performing a detailed ultrasoound and not performing a consult nor will we trust an outside OB to give findings and set an appropriate plan of care. Our practice is a "consult only" practice and does not provide primary care and we are not set up as a radiology-type center either. Our providers see every patient receiving ultrasound services.