Coding

There are new hospital quality initiatives for identifying patients at risk for accreta spectrum disorder.  We are seeing a tremendous amount of referrals for the sole indication of prior cesarean delivery.  We typically perform the elements of a targeted fetal anatomic survey (because we do that on all patients), use color doppler, and transvaginal imaging.  Should we be billing 76811 or 76805 along with the TV 76817?

Hi Elizabeth,

Placenta accreta spectrum is an indication for 76811. Please note the corresponding white paper from the SMFM Coding Committee at: https://www.smfm.org/coding/white-papers/131-smfm-coding-committee-white-paper-coding-for-placenta-accreta-spectrum

Fadi

There are new hospital quality initiatives for identifying patients at risk for accreta spectrum disorder.  We are seeing a tremendous amount of referrals for the sole indication of prior cesarean delivery.  We typically perform the elements of a targeted fetal anatomic survey (because we do that on all patients), use color doppler, and transvaginal imaging.  Should we be billing 76811 or 76805 along with the TV 76817?

I of course agree with Dr. Bsat.....76811

Hi Elizabeth,

Placenta accreta spectrum is an indication for 76811. Please note the corresponding white paper from the SMFM Coding Committee at: https://www.smfm.org/coding/white-papers/131-smfm-coding-committee-white-paper-coding-for-placenta-accreta-spectrum

Fadi

There are new hospital quality initiatives for identifying patients at risk for accreta spectrum disorder.  We are seeing a tremendous amount of referrals for the sole indication of prior cesarean delivery.  We typically perform the elements of a targeted fetal anatomic survey (because we do that on all patients), use color doppler, and transvaginal imaging.  Should we be billing 76811 or 76805 along with the TV 76817?

Hello,

May I please clarify the billing of 76811 in this context? In the first clinical coding scenario in the white paper (thank you for the link), it is stated that a 76805 should be coded because the patient was not referred for suspected PAS, even though the placenta was located over the prior C/S scar. 

For patients referred for anatomic survey for the indication of prior cesarean delivery (as I understand to be the situation in Dr. Spooner's original question), should the referring provider then be asked specifically to state "evaluate for PAS" in the referral? 

Our office's referral form for ultrasound has the verbiage "as clinically indicated" (eg, patients are most commonly referred for "first-trimester ultrasound with NT, anatomic survey, and follow up as clinically indicated). Would this suffice as justification to bill a 76811 if a history of cesarean is discovered upon review of records or by patient report, or if a placenta previa is seen, as long as a detailed evaluation of the placenta is indeed performed? 

Thank you!

I of course agree with Dr. Bsat.....76811

Hi Elizabeth,

Placenta accreta spectrum is an indication for 76811. Please note the corresponding white paper from the SMFM Coding Committee at: https://www.smfm.org/coding/white-papers/131-smfm-coding-committee-white-paper-coding-for-placenta-accreta-spectrum

Fadi

There are new hospital quality initiatives for identifying patients at risk for accreta spectrum disorder.  We are seeing a tremendous amount of referrals for the sole indication of prior cesarean delivery.  We typically perform the elements of a targeted fetal anatomic survey (because we do that on all patients), use color doppler, and transvaginal imaging.  Should we be billing 76811 or 76805 along with the TV 76817?

Hello Amy,
You make a good point. With an anterior placenta and prior C-Section, we still image the placenta with added modalities and time to rule out accreta. To me, that justifies 76811 as long as all its elements are met. This is similar to looking for a fetal structural anomaly in a patient at increased risk (AMA, diabetes, etc.) and billing 76811 even when an anomaly is not found. If the placenta is posterior or fundal, and the possibility of accreta is low by clinical history (no prior ablation, myomectomy, etc.), then billing 76805 would be reasonable as prior C-Section alone is not an approved indication for 76811, Perhaps the coding committee can consider a revised recommendation to its first example.

Be that as it may, payers will likely follow what the committee suggests, which in turn follows guideline from national organizations.

Fadi

Hello,

May I please clarify the billing of 76811 in this context? In the first clinical coding scenario in the white paper (thank you for the link), it is stated that a 76805 should be coded because the patient was not referred for suspected PAS, even though the placenta was located over the prior C/S scar. 

For patients referred for anatomic survey for the indication of prior cesarean delivery (as I understand to be the situation in Dr. Spooner's original question), should the referring provider then be asked specifically to state "evaluate for PAS" in the referral? 

Our office's referral form for ultrasound has the verbiage "as clinically indicated" (eg, patients are most commonly referred for "first-trimester ultrasound with NT, anatomic survey, and follow up as clinically indicated). Would this suffice as justification to bill a 76811 if a history of cesarean is discovered upon review of records or by patient report, or if a placenta previa is seen, as long as a detailed evaluation of the placenta is indeed performed? 

Thank you!

I of course agree with Dr. Bsat.....76811

Hi Elizabeth,

Placenta accreta spectrum is an indication for 76811. Please note the corresponding white paper from the SMFM Coding Committee at: https://www.smfm.org/coding/white-papers/131-smfm-coding-committee-white-paper-coding-for-placenta-accreta-spectrum

Fadi

There are new hospital quality initiatives for identifying patients at risk for accreta spectrum disorder.  We are seeing a tremendous amount of referrals for the sole indication of prior cesarean delivery.  We typically perform the elements of a targeted fetal anatomic survey (because we do that on all patients), use color doppler, and transvaginal imaging.  Should we be billing 76811 or 76805 along with the TV 76817?