Prenatal Ultrasound Vs Echo cardiography:
Your question is whether we could give fetal echocardiography (code) to a elderly pregnant patient instead of or along with Ultra sound 76811 and can both be coded at the same day of service is that you wanted?
Well the foremost answer is if the doctor provided both on the same day and documented, yes you should ,you know, it is doctors decision , service and documentation.
Usually they do not do that both at the early weeks of pregnancy. What they provide at the appropriate time of knowing the anatomy of the fetus normally, around the 16weeks of pregnancy when the whole anatomy of the fetus can be better studied/evaluated rather than the earlier weeks when the anatomy can not be detailed very well for sure. What the obstetrician makes this time is the gross anatomy of the whole fetus structure including the brain, kidney and the heart with its chambers (the ‘4Chamber View’ of the fetal heart, we call it), kidney and very structures including the sex. I said it is a gross evaluation of all the fetal structure. THIS ONLY This is different from the ECHO CARDIOGRAPHY which usually requested for once the physician suspects any anomaly of the heart. Both are basically technically and and structurally different from each other. Fetal echocardiograms are usually performed in the second trimester of pregnancy, at about 18 to 24 weeks.
{There are 3types of Echo:
-D (2-dimensional) echocardiography:
This technique is used to "see" the actual structures and motion of the heart structures.
Doppler echocardiography:
This Doppler technique is used to measure and assess the flow of blood through the heart's chambers and valves. The amount of blood pumped out with each beat is an indication of the heart's functioning. Also, Doppler can detect abnormal blood flow within the heart, which can indicate such problems as an opening between chambers of the heart, a problem with one or more of the heart's four valves, or a problem with the heart's walls.
Color Doppler:
Color Doppler is an enhanced form of Doppler echocardiography. With color Doppler, different colors are used to designate the direction of blood flow. This simplifies the interpretation of the Doppler images
The code 76825 is for the first variety I gave above.} . However, a fetal echocardiogram is a very detailed evaluation of the heart by a specialist in fetal echocardiography.
Some heart abnormalities are not detectable prenatally even with a detailed expert examination. These tend to be minor defects, such as small holes in the heart, or mild valve abnormalities. In addition, some cardiac defects do not become evident until after birth.
The fetal echocardiogram focuses on the heart. The fetal echocardiographer may not see defects in other parts of the fetus.
It is not necessary for all pregnancies to receive an echocardiogram. The prenatal ultrasound tests that are done prior to birth can give information about whether the fetal heart has developed with all four chambers. Most unborn babies do not require any further testing.
Situations in which a fetal echocardiogram may be necessary include, but are not limited to, the following:
• if a sibling was born with a congenital (present at birth) heart defect
• a family history of congenital heart disease (such as parents, aunts or uncles, or grandparents)
• a chromosomal or genetic abnormality discovered in the fetus
• if a mother has taken certain medications that may cause congenital heart defects, such as anti-seizure medications or prescription acne medications
• if the mother has abused alcohol or drugs during pregnancy
• if a mother has diabetes, phenylketonuria, or a connective tissue disease such as lupus
• if the mother has had rubella during pregnancy
• a routine prenatal ultrasound has discovered possible heart abnormalities
• a routine prenatal ultrasound has identified other congenital (present at birth) anomalies such as kidney, brain or bone abnormalities.
YOUR MOTHER (under topic discussion) of ELDERLY PRIMI/AMA REASON ALONE, though the congenital anomaly rates go in multiples as age advances especially after 40s, may not necessitate an echo, but when the obstetrician finds some doubt about, she or he has every right to do it for the benefit of doubt an dmore so for inuterotreatment purposes.
So to cut short my story, when the doctor has done it on the same day around the period of clarity of details -from 18-24 weeks and even after any time before delivery, it is our duty to code it separately from the routine or even repeated prenatal ultrasound, which is a totally different procedure with a different technique and machine.
So code always both separately, as long as it is not bundled!!. This is my logically and clinically justified openion.
Hope you get the answer out of this.
Thank you
