Wiki New OB pt Ultrasounds

[Scruz09]

Hello Everyone,

Hopefully someone can point us in the right direction as how this is supposed to work.

Our physicians tend to do a lot of ultrasounds (including a quick look at their first OB visit). We would bill the 76817 with a Dx of V28.3 (Encounter for routine screening for malformation using ultrasonics) even if nothing of note was found. Well...this code has now been crosswalked into Z36 for routine fetal ultrasound. (Keep in mind that just about every screening has been crosswalked into that Z36 code).

But now we are starting to see some denials as improper dx. The only other code I can think of that would apply would be O35.8xx0 for a single gestation. Would the documentation need to state that they physician performed this ultrasound looking for a specific abnormality? Is this something we should be expecting to not get reimbursed on?

Any guidance would be greatly appreciated.

Thank you!

 

[Cmama12]

I'm not sure how the z36 is going for our organization at this point, but yes, it's funny how ICD -10 is more specific for some things, and not so much for others... like OB. There have been a few codes taken away that we are not happy with lol..

But I digress. For a 76817 when it's their first one, I have been using the o36.80x0 for inconclusive viability. For other U/S down the road, I am using the z36 unless there is another reason mentioned.. I do find there is usually something else like elderly multigrav, or obesity, gest diabetes, etc.

There are also the Z03. equivalents of v89 codes, encounter for suspected fetal anomaly ruled out, etc. - you could try adding those if you know what they were looking for.

 

[Scruz09]

How has the Z36 treated you in terms of payment? Are they getting paid or do you not remittance back yet?

Thanks for the replay BTW

 

[Cmama12]

I have not heard anything yet. I tried looking in some of the denail workques, but there are so many of them.. I didn't see any so far. Are you getting commercial denials or medicaid,medicare.. or all the above?

 

[Scruz09]

Most of the ones I've seen have been Medicaid related but that's across the board. Medicaid well codes aren't seeming to do so well either. I have one of our reps looking into it at the moment. When I find out more, I can let you know.

 

[mitchellde]

I'm not sure how the z36 is going for our organization at this point, but yes, it's funny how ICD -10 is more specific for some things, and not so much for others... like OB. There have been a few codes taken away that we are not happy with lol..

But I digress. For a 76817 when it's their first one, I have been using the o36.80x0 for inconclusive viability. For other U/S down the road, I am using the z36 unless there is another reason mentioned.. I do find there is usually something else like elderly multigrav, or obesity, gest diabetes, etc.

There are also the Z03. equivalents of v89 codes, encounter for suspected fetal anomaly ruled out, etc. - you could try adding those if you know what they were looking for.

For a routine first ultrasound the Z36 is the correct code. The O36.80x0 is an incorrect code for a routine ultrasound. This code indicates the provider has documented that there is a question as to viability of the fetus such as inability to obtain a heartbeat. The Z03 codes are the same the documentation must indicate that an issue is suspected and the ultrasound ruled it out.
There should be no issues with using the Z36 code for routine antenatal testing.

 

[YV@OBGynJax]

Using Z36 for screening OB ultrasounds

Its now March of 2016 and I'm now getting denials for using Z36 by itself. The insurance companies want other Dx. However, even after adding other Dx. (AMA or Obesity) they still seem to deny. Not sure about using the Z03.7 codes along with Z36.

 

[slandstra]

Are you adding the week of pregnancy as your secondary code i.e. Z36, Z3A.20? I have had no trouble receiving payment for ultrasounds with the 2 codes.

 

[Anastasia]

Some carriers in Pennsylvania have started denying screening OB ultrasounds. They want a medical indication. We did get a list from the carriers of the diagnoses they will accept. I would contact the carriers that are denying and try to get their approved list of diagnoses for these ultrasounds. This trend might be a result of over-utilization.