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Re: Maternal Fetal Medicine FoundationFrom: Dave Berck (djberck@yahoo.com)Sun Sep 25 05:52:50 2005
>From Josh Copel: There are 2 questions here and I'll try to address them both. First, full disclosure: I am on the Maternal Fetal Medicine Foundation committee of the Society for Maternal-Fetal Medicine, and I was on the committee that helped develop the 76811 code. 1. The Maternal Fetal Medicine Foundation was set up recently by SMFM to provide NT education & ongoing quality monitoring in the US. It is based fully on the standards of Kypros Nicolaides. It offers web based education and submission of images for initial qualification. MFMF is working with the major private and university labs to develop automatic submission of NT data from practices and will provide quarterly feedback to sonographers and sonologists on how their measurements compare with standards, so that "assay drift" in your measurements can be identified. Anyone who is FMF(UK)-certified by Kypros Nicolaides' group can sign up at no initial cost for a limited time. All money goes to a 501c3 not-for-profit corp. Information is available at <http://www.mfmf.org>. 2. The 76811 code is intended for pregnancies with identifiable risks for fetal or genetic abnormalities (beyond the background risk inherent in all pregnancies). I suspect that the Aetna is using ICD codes that are associated with those risks (AMA, previously fetal anomaly), though I have no specific information on the ICD codes they are accepting for reimbursing 76811. Now I know this is not a popular position, but the 76811 code is not just for doing a thorough scan, it is for those pregnancies with risks. Also, remember that 76805 is not a limited scan, it is a basic fetal scan. This includes a fair amount of anatomic evaluation, though remember there is also a different level of liability for the two types of scan. Joshua Copel Orlando Ultrasound <orlandoultrasound@hotmail.com> wrote: Of those out there whom do insurance billing for fetal ultrasound exams (76811-full detailed fetal studies), what do you think of Aetna's reimbursement guidelines. They have taken statements from the maternal fetal medicine organizations and formed a reimbursement plan to pay for this code with a few distinct ICD codes. If those codes are not met then they will only pay for the limited 76805 exam/code. The lesser code only pays about 53% of the detailed exam. Is anyone in this ultrasiound scanning realm facing this issue, and what are you doing to circumvent this problem. Kevin Kevin Snider RDMS,RDCS,RVT Chad Hall RDMS, RDCS, RVT Orlando Ultrasound Associates, Inc. Diagnostics - Consulting- Education Office: (407)273-7303 Toll Free: (866)-613-7303 Fax (407) 381-2502 Reply-To: ultrasound@obgyn.net To: Multiple recipients of list ULTRASOUND <ultrasound@dns.obgyn.net> Subject: Maternal Fetal Medicine Foundation Date: Fri, 23 Sep 2005 21:16:07 -0500 I have just been invited to join the Maternal Fetal Medicine Foundation and to give them money. They seem to be involved with quality assurance for NT measurements / 1st trimester screening. Does anyone have any experience with this organization? Who does my money go to? Why should I give them money to do something the FMF and NTD labs do for free? I'm trying to justify membership in yet another organization. Thanks.
-- Dave Berck, MD, MPH
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