Coding Obstetrical Ultrasounds

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For dates of service prior to January 1, , Anthem will continue to process claims with the previously approved CPT codes until December 31, If you have authorized treatment plans dating after January 1, , we will contact you to change the authorized CPT codes for .

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Each code description should be reviewed carefully along with the ultrasound guidelines to make sure you are selecting the correct code. CPT codes used for OB ultrasounds are Choosing the correct code is based on the documentation in the report. What is a complete OB Ultrasound? If more than one fetus is documented, is assigned per each additional gestation in addition to Note that the description for a complete exam for a fetus 14 weeks and 0 days and older is slightly different.

Without this documentation, the limited study code, , should be assigned. This code may only be used one time regardless of the number of fetuses documented. Other OB Ultrasound Codes Code is used to code a limited exam when all elements needed to code a complete exam are not documented in the report. This code is often used when only a “quick look” is necessary to assess one or more specific elements such as amniotic fluid, fetal weight, etc. Code is used to bill a follow-up study.

The study is done to reassess size and interval growth or an abnormality previously discovered on a prior ultrasound.

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CPT Code(s) ** , , , or * *The AMA CPT codebook contains the component CPT codes and the new MAAA codeset. Please direct any questions regarding coding to the payor being billed.

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Ultrasound for Pregnancy

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However, the quad screen looks for not only the three specific substances evaluated in those tests AFP, hCG, and Estriol but also a fourth substance known as Inhibin-A. The screen is essentially the same as the screening tests that look for only three substances, except the likelihood of identifying pregnancies at risk for Down Syndrome is higher through the evaluation of Inhibin-A levels. The false positive rate of the test is also lower. What is a screening test?

It is very important to remember what a screening test is before getting one performed. This will help alleviate some of the anxiety that can accompany test results. Screening tests do not look only at results from the blood test. How is the quad screen test performed? The quad screen test involves drawing blood from the mother, which takes about 5 to 10 minutes.

The blood sample is then sent to the laboratory for testing. The results usually take a few days to receive. What are the risks and side effects to the mother or baby?

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First trimester ultrasound is performed in the first months of a pregnancy. Pregnancy ultrasounds are performed mainly using transabdominal ultrasound. For many women, especially after 8 weeks gestation, sufficient information about the baby may be obtained with transabdominal ultrasound only. However, in the early pregnancy, the developing embryo is very small at 6 weeks gestation, the baby is only mm long and a transvaginal ultrasound may be required to get a better image of the baby.

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Thank you for the topic R. I hope I would brief a little about it. Fetal growth and date Detection as early as when? It is recommended that all pregnant women have a scan in the first trimester at around 12 weeks of pregnancy to confirm their dates. First trimester ultrasonic scans may show ‘soft’ markers for chromosomal abnormalities, such as an increased fetal nuchal translucency back of the neck to enable detection of Down’s syndrome fetuses.

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Aetna considers detailed ultrasound fetal anatomic examination experimental and investigational for all other indications including routine evaluation of pregnant women who are on bupropion Wellbutrin or levetiracetam Keppra , pregnant women with low pregnancy-associated plasma protein A, and pregnant women who smoke or abuse cannabis. There is inadequate evidence of the clinical utility of detailed ultrasound fetal anatomic examination for indications other than evaluation of suspected fetal anatomic abnormalities.

Detailed ultrasound fetal anatomic examination is not considered medically necessary for routine screening of normal pregnancy, or in the setting of maternal idiopathic pulmonary hemosiderosis. CPB – Fetal Echocardiograms. Ultrasonography in pregnancy should be performed only when there is a valid medical indication.

ACOG stated, “The use of either two-dimensional or three-dimensional ultrasonography only to view the fetus, obtain a picture of the fetus, or determine the fetal sex without a medical indication is inappropriate and contrary to responsible medical practice. This recommendation is based primarily on consensus and expert opinion Level C. ACOG stated that it may be possible to document normal structures before 18 weeks of gestation but some structures can be difficult to visualize at that time because of fetal size, position, and movement; maternal abdominal scars; and increased maternal abdominal wall thickness.

A 2nd or 3rd trimester ultrasound examination, however, may pose technical limitations for an anatomic evaluation due to suboptimal imaging, and when this occurs, ACOG recommended documentation of the technical limitation and that a follow-up examination may be helpful.

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