Nuchal Translucency Credentialing & Coding
Authors: The Society for Maternal-Fetal Medicine (SMFM) Coding Committee; Steve Rad, MD, FACOG; Brad Hart, MBA, MS, CPC, CPMA, COBGC; Vanita Jain, MD, FACOG.
Background: First trimester screening includes biochemical markers, fetal nuchal translucency (NT) assessment via ultrasound (CPT 76813; 76184), and cell-free fetal DNA (cfDNA) screening. With the introduction and increasing use of cfDNA screening, there have been recent changes in clinical guidance, individual payer guidelines, and NT credentialing education programs. Clinical practice varies nationally and internationally. Current ACOG and SMFM clinical guidance continue to recommend that NT ultrasound assessment be discussed and offered to all patients as one of the genetic screening modalities used in pregnancy (ACOG PB 226, 2020; SMFM Consult Series 42, 2017; SMFM Coding Committee White Paper Coding for the new First Trimester Detailed Diagnostic Ultrasound, 2021). The current national AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12w0d-13w6d (2020) and the international ISUOG Practice Guidelines: Performance of 11–14-week ultrasound scan (2023) require NT assessment as part of the detailed first trimester ultrasound. In 2023, the US Perinatal Quality Foundation (PQF) which manages the Nuchal Translucency Quality Review (NTQR) program announced that it will close in December 2023. Per the PQF, some laboratories will continue to honor the NTQR credential through December 2024 for combined risk assessment. Also, per the PQF, if you predict that you or your practice will be using combined risk assessment after December 2024 or if you use a laboratory that will not be honoring the NTQR credential after 2023, physicians and sonographers are directed to apply for NT credentialing through the Fetal Medicine Foundation (FMF).
With all these recent changes, a coding update is important for MFM specialists and their practices. Is it required from a coding standpoint for physicians and/or sonographers to be certified for NT ultrasound assessment?
No. AMA guidelines for CPT 76813 & 76814 (Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach) do not require NT credentialing to report these specific CPT codes. This has been true even prior to the advent of cfDNA screening.
Although the SMFM Coding Committee does not provide clinical, credentialing and/or practice management guidance, awareness and vigilance is advised for sonographers and physicians if considering or deciding NOT to continue NT credentialing in your individual practices at this juncture. While credentialing is not required by the AMA CPT guidelines to submit these codes as noted above and in the setting of the shift to cfDNA as a primary genetic screening test and the announcement from the PQF NTQR regarding closure this year, it is important to be aware that NT certification (through NTQR and/or UK FMF) will continue to be required by some payers, laboratories, ultrasound associations, institutions, and practices. That is, payer, lab, and organization guidelines can differ from AMA CPT guidelines. Furthermore, credentialing has also been shown to improve operator standards, quality assurance and outcomes in the literature, which may be important to your individual prenatal diagnosis centers on an ongoing basis. In addition, you may be aware that the SMFM is focusing efforts on coding for the Detailed First Trimester Ultrasound (DFTU) examination; as noted above, NT assessment will continue to be part of this study and certification is expected to continue to be required as part of the practice parameters for this examination (details re coding, billing and exact training/certification requirements for DFTU are currently being evaluated and worked on). In sum, we anticipate that some payers and other organizations may continue to require NT credentialing/certification for the time-being; thus, the Committee recommends taking this into consideration in your practice management. As always, the Coding Committee recommends contacting each payer directly for further individual clarification.