The detailed ultrasound is for a medical indication. It's a suspected fetal anomaly during the first exam, severe intrauterine growth retardation of the fetus, patients who have diabetes. If you have an elevated AFP either serum or amniotic fluid you're going to want to do a detailed exam. If there's oligo or polyhydramnios document then you might want to do one of these. If a two-vessel cord was found in level I exam, you'll probably go on and do a detailed exam.
In order words, a detailed exam is not an ante-natal screening exam. It must be done for a medically suspected condition. And you must document that in order to get it paid.
That detailed exam again is going to include under the CPT guidelines, the fetal brain and ventricles, the face, the heart, outflow tracts, chest anatomy, abdominal organs to the specific anatomy. In order words, it needs to specify each organ and what was seen for each organ, number, length and architect of limbs, evaluation of umbilical cord.
Some sonographers argue, “Oh, we have a machine that does this, you know, to print you out this wonderful report.” So, you know, we were taught in school to do all of these things and that's fine and all good and well, guys. But if you don't have a medical indication for doing that level of exam, the payer is not going to reimburse you for it and that's the issue.
Just because you can do a detailed exam does not mean it's medically indicated in this case for this patient.
There are two codes for nuchal translucency scan, one is for the first fetus or a single gestation and the second code is the add-on for the additional fetus.
This scan requires – even though CPT does not talk about this specifically but if you look at any document talking about nuchal translucency scan, it will indicate that it has to be measured by the documentation needs to include crown and rump length, verification of sagittal view of fetal spine and three measurements of the maximum thickness between the skin and soft tissues over that cervical spine, and of course, image documentation and a final written report.
If your sonographer doesn't have the special training, payer is not going to reimburse you for this one. This is something that's hard to see. And the other thing with the nuchal translucency, you would do it between 11 and 14 weeks.
You would not do it after that time period because it doesn't give you accurate information. And you don't want to do it before that time period because it's not as accurate. Payers are actually now denying any NT scan done after 14 weeks. So, just so you know that that's the protocol and that you get it in within that time frame.
Okay, 76816 describe a reassessment or re-evaluation of something that was picked up in the original scan. So, it's the serial ultrasounds that are done for IUGR in a fetus. For instance, it is looking at one or more anatomic abnormalities of the fetus that were seen on the previous ultrasound and you're following it to see if it disappears. The follow-up ultrasound has slightly fewer relative values in it than a limited ultrasound.
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