Z36 - Medicaid


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In our office we will do a dating ultrasound in which we use Z36 and Z3A. Patients are also offered genetic screening, some will have a specific diagnosis that we can use but for other simply wanting it for peace of mind we have been using the code Z36 also. Up until recently we haven't had a problem getting Medicaid to pay for it, but now we are getting denials using that diagnosis for QUAD screens of the NT blood work that goes with the ultrasound. We will get the nuchal ultrasound paid for using that code but not the blood work. I was wondering if anyone else is having this issue and if they have found anything that works.

There is Z13.89, screening for anomaly congenital
I also see there is Z03.7 encounter for suspected maternal and fetal conditions ruled out, but don't feel as though this is the right route to take.

I have doctors upset that they are now not paying for it and wanting a solution to the problem. My only thing is that Medicaids are the only ones that we are having this issue with.

Any help is appreciated.