Wiki Routine anatomy scan ordered MFM billing 76811

[cubbiecatz]

Hello. We are helping with MFM billing and I have a question on an ultrasound.
Patient was seen by primary OB and routine scan ordered. During the ultrasound the MFM discovers fetal growth is 98% percentile for gestational age.
I know 76811 is for high risk and I was given some codes as examples but LGA wasn't included. Is that considered a high risk diagnosis and we can bill 76811? All of the required elements were peformed for 76811.
Thank you!

Cathy Satkus, CPC, COBGC
St. Francis Health System
Tulsa, Ok

 

[nielynco]

Hello. We are helping with MFM billing and I have a question on an ultrasound.
Patient was seen by primary OB and routine scan ordered. During the ultrasound the MFM discovers fetal growth is 98% percentile for gestational age.
I know 76811 is for high risk and I was given some codes as examples but LGA wasn't included. Is that considered a high risk diagnosis and we can bill 76811? All of the required elements were peformed for 76811.
Thank you!

Cathy Satkus, CPC, COBGC
St. Francis Health System
Tulsa, Ok

So this is not making sense to me. The patient's ob/gyn sent the patient to an MFM for a routine scan? There would be no need to do this unless her ob thought there was a problem and then a possible diagnosis should have been given to the MFM office as the reason the detailed scan was requested. I would go back and check the documentation request on this one. Normally LGA is not a reason to perfom a detailed ultrasound as this finding can be determined with a routine ultrasound and is not normally caused by an abnormality with the fetus (but rather may be due to a diabetic mother, the mother has gain too much weight too fast, the mother is large and there is a family history of large babies, etc.).

 

[cubbiecatz]

So this is not making sense to me. The patient's ob/gyn sent the patient to an MFM for a routine scan? There would be no need to do this unless her ob thought there was a problem and then a possible diagnosis should have been given to the MFM office as the reason the detailed scan was requested. I would go back and check the documentation request on this one. Normally LGA is not a reason to perfom a detailed ultrasound as this finding can be determined with a routine ultrasound and is not normally caused by an abnormality with the fetus (but rather may be due to a diabetic mother, the mother has gain too much weight too fast, the mother is large and there is a family history of large babies, etc.).

I'm glad you said that because the fact the patient was sent to MFM did not make sense to me. No problems are noted for the patient, her BMI is 25 and the ultrasound was ordered on her initial prenatal visit. The provider did not put in the note that she specifically wanted MFM. This is her note:
Patient is here today for initial prenatal visit. She denies vaginal bleeding, abdominal pain, or cramping. Labs and ultrasound results reviewed and discussed with patient. A prescription for prenatal vitamins have been provided. Medications in pregnancy sheet provided as well as tip sheet for nausea/vomiting. Discussed anticipated course of prenatal care, including use of ultrasound and when labs/tests are routinely performed. Precautions for SAB have been reviewed. Routine anatomy scan ordered. NIPT ordered. Declined CF screening.

Thank you, Cathy