Check back regularly for news and updates from SMFM.
A consultation is a type of service provided by a physician whose opinion or advice regarding Evaluation and Management (E/M) of a specific clinical problem is requested by another physician or other appropriate source. CPT consultation guidelines further define an “appropriate source”... Continue Reading
Chorionic Villus Sampling (CVS) is a prenatal test that detects chromosomal abnormalities such as Down syndrome, as well as a host of other genetic disorders.CVS is a diagnostic procedure which involves removing some chorionic villi cells from the placenta at the point where it attaches to the... Continue Reading
Multiple scans may be billed on the same patient for the same date of service, as long as they are medically necessary and documented appropriately. Below are some examples on how to report the scans based on locations:Ultrasound performed at the office POS 11:768xx with No ModifierUltrasound... Continue Reading
A variety of cell-free DNA (cfDNA) analysis methods have been developed to test for fetal trisomies in maternal blood. These tests fall into two categories: · Random Sequencing and · Directed DNA Analysis. Random sequencing analyzes a random subset of cfDNA... Continue Reading
Recently, a question was posed on the appropriate way to report coding combination 76821 and 76815. Some insurance companies are denying 76815 “incidental” to 76821. Does using a modifier prevent this coding combination from being denied?According to Medicare National Correct Coding... Continue Reading
The SMFM Coding Committee frequently receives questions on the appropriate way to report and receive reimbursement when ultrasound services are provided to hospitalized patients.Global Billing-services are provided and can be billed as Global only when the practice:* owns or leases the equipment,... Continue Reading
In the ever changing world of health care and overall rising costs, co-payments are no longer ONLY applied for certain specialties and are NOT always driven by Place of Service or E&M Visits. The industry has increased cost shifting from insurance plan to patient creating a more self-pay... Continue Reading
The CPT 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination) is not intended to be the routine scan performed for all pregnancies. Rather, it is intended for a known or suspected fetal anatomic, genetic... Continue Reading
Dear Members, and Coders:It is felt by all organizations involved in the codes development and description that only one medically indicated CPT 76811 per pregnancy, per practice is appropriate. Download the PDF Continue Reading
Several members have approached the SMFM and inquired about the options for billing for services performed by a Nurse Practitioner.The way you report the service depends on how the payers have the Nurse Practitioner credentialed. When billing for a Non‐Physician Provider (NPP), you have the... Continue Reading
This White Paper will deal with the “Radiology Bundling Rule” (RBR) to provide the SMFM Coding Committees recommendations for the optimal reporting and obtaining proper reimbursement for multiple obstetrical ultrasounds performed on the same day with special focus on avoiding second... Continue Reading
Dear Members, and Coders,The purpose of this White Paper is to advise members of the definition of a Taxonomy Code, clarification of 'specialty'and 'sub-specialty'and proper usage. Download the PDF Continue Reading
