Wiki Anatomy ultrasounds

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SueLis

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We are using Z36 on our Anatomy scans. All of our insurance carriers are paying for this dx except for some of our Blue Cross Blue Shield of Michigan plans. They are denying the anatomy ultrasound for non covered dx. We have had our pt's call BCBS and they are being told this is not a maternity dx. Z36 states encounter for antenatal screening and I noticed it only has the female icon and not the maternity one (which I thought was strange since it antenatal screening). One of our pt's had their BCBS rep find a payable code with BCBS which was Z34.00 Encounter for supervision of normal pregnancy (which I feel is not an appropriate code to use). Is anyone else having problems with this dx??????:eek:
 
Yes I am having the same issue. I feel that Z34.00 would be inappropriate to use as we do not know that it is a normal pregnancy, as the scan could prove otherwise.
 
We have just been informed that Medicaid is not accepting Z36 as a primary diagnosis. Many of the ICD 9 codes cross-walked to Z36. Maybe we will lean towards suspected not found diagnosis?
 
Here in Pennsylvania, several carriers are denying the routine screening diagnoses. We have lists of the medical diagnoses they will cover. I believe they are trying to cut down on the number of ultrasounds performed unless it is medically indicated.
 
jpetit said:
We have just been informed that Medicaid is not accepting Z36 as a primary diagnosis. Many of the ICD 9 codes cross-walked to Z36. Maybe we will lean towards suspected not found diagnosis?
Click to expand...

The GEMS file I'm looking at only V28.89 mapped to it
 
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