In situations where all elements are performed but some structures cannot be visualized, the physician is entitled to report and receive the entire reimbursement for procedure. For further clarification, we suggest that you review the SMFM White Paper on the 76811, which can be located on the website. If the patient is coming back to complete the anatomy that was not initially seen, a follow-up ultrasound 76816 Follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan) should be reported accordingly. When the structures cannot be visualized, it needs to be clearly noted in the body of the ultrasound report as to why ie: ("Unable to visualize due to early gestational age", "Unable to visualize due to fetal position") etc. As far as referral for the follow-up ultrasound, although it is typically not a requirement, it's helpful to obtain the referral. Below is the answer for SMFM coding question #1321, which is archived on the web site.
COMPLETE ANATOMY BILLING CODE
In these scenarios, the follow-up scan is the appropriate code to use. University of Kentucky College of Medicine
COMPLETE ANATOMY BILLING FULL
If a full growth is performed along with follow up anatomy - I would bill a 76816. I would bill a 76815 if only the very limited missing anatomy component is re-imaged. If this is a follow up due to inability to obtain all images - then the coding depends on what was re-imaged - i.e. I would use a 76805 or 76811 - as applicable for the initial anatomy scan - I would not use one after the other if this was an early (16 week anatomy) - followed by another detailed anatomy.
COMPLETE ANATOMY BILLING HOW TO
As to how to bill for the follow-up study to complete the fetal anatomy survey, I recommend using 76816, not 76805.
So you have 2 options for confirming a follow-up request: (1) obtain an order for the follow-up study each time, or (2) have written agreement from your referring providers that a follow-up will be scheduled since the anatomy was not fully documented in the first visit (76811 or 76805). So you have 2 options for follow-up: (1) obtain an order for the follow-up study each time, or 92) have written agreement from your referring providers that a follow-up will be scheduled since the anatomy was not fully documented in the first visit (76811). Pennstate Milton S Hershey Medical Center I am wondering how others handle the situation.Īssociate Professor of Obstetrics & Gynecology and Pathology At one time we were coding and billing for the follow-up as a 76816, we recently switched to the code 76815. The way our practice has dealt with this is to schedule the follow-up before the patient leaves then ask for the original referring physician to sign off on an order for the follow-up scan. The anatomy survey is incomplete and we suggest a follow-up to complete. The situation is a patient comes in for a fetal anatomy survey, either routine screening 76805 or detailed, with appropriate indication, 76811. I was wondering how others deal with referral, coding and billing for follow-up fetal anatomy surveys.
Subject: referral, coding and billing for follow-up fetal anatomy surveys
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