Re: experience with reimbursement for 3D 4D ultrasound?

From: R Depp (Stork2001@comcast.net)
Fri Jan 19 10:53:26 2007

The SMFM Website has access to a Coding area which addresses circumstances for coding, appropriate codes, indications etc. The group has for instance working with AETNA to come up with codes for NT which become active this month (requires discussion with regional insurers). Your practices / billing service can have access to this coding service for a nominal yearly fee which most feel is the PLACE. Many of the insurers, including AETNA use the site as the arbitrator for OB and GYN ultrasounds - thanks to the work of Dan O'Keeffe and others.

I am no expert on coding, but understand that the number of units for post processing is small and the reimbursement is small, that most of reimbursement is in the technical component. Not a fact, but my memory.

rd

Richard Depp, MD Exec VP, Society for Maternal Fetal Medicine 1280 Club House Road Gladwyne, PA 19035 610-527-5712 (NEW)

-----Original Message----- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Cheryl Turner Sent: Friday, January 19, 2007 12:35 PM To: Multiple recipients of list ULTRASOUND Subject: Re: experience with reimbursement for 3D 4D ultrasound?

76376 is 3D rendering and interpretation and reporting of CT, MRI Ultrasound

not requiring image postprocessing on and independent workstation

76377 is 3D requiring image postprocessing on an independent workstation

what we are using, now whether we are getting paid? I dont know. We got this

code from GE and its in the CPT 2006 code book

Now with not only the ob 3D, but the STIC of the heart, and volume coronal plane for uterine polyps and uterine malformations, misplaced IUDs, volume measurements of lungs for diaphragmatic hernia repair, it can be justified for lots of things. Of course, that doesnt mean the insurance will pay.

Cheryl Turner, BS, RDMS Inner Vision Women's Ultrasound

>From: DuBoseTerryJ@UAMS.edu (Terry J DuBose)
>Reply-To: ultrasound@obgyn.net
>To: Multiple recipients of list ULTRASOUND <ultrasound@dns.obgyn.net>
>Subject: Re: experience with reimbursement for 3D 4D ultrasound?
>Date: Fri, 19 Jan 2007 11:11:08 -0600
>
>This reimbursment issue has come up again with our folks. Does anyone
>in the USA have anything new, or answers to the question:
>
>"Yes i have been searching AIUM and ACOG....but nothing.....as far as i
>know there is NO CPT code......
>this is one thing we are working on: I guess we are going to make some
>kind of guideline maybe.....do you have any suggestions....."
>
>"I need for you to look up a good description of what thins we should
>allow the 3-d 4- us to be applied to. i.e. heart? Cleft lip palette?
>Spine? May be we could also limit it to AIUM certified labs. Judith
>wants this."
>
>Thanks, Terry
>
>---------------------------
>
>---------------------------
>At Wed, 18 Jan 2006, James Smeltzer wrote:
>---------------------------
> >
> >Hi! Color flow mapping is 93325. Paid at about $4 when we get paid.
> >Offline 3-D code I know about was developed for 3-D post-processed
> >analysis of MRI & CTS. We have only used a few times. I only have one
> >case of DS not diagnosed by 2-D but done by 3-D on facial morphology -
> >which was quiet clear. What CPT are you talking about? JimS
> >
> >--
> >James S. Smeltzer, MD, FACOG, SMFM
> >Consultant, Maternal Fetal Medicine
> >Wellstar Physicians' Group
> >Northwest Women's Care
> >787 Campbell Hill St
> >Marietta GA 30060
> >James.Smeltzer@wellstar.org
> >VM 678-290-3035
> >Off 770-528-0260
> >Page 404-318-3451
> >
> >>>> sylultra@hotmail.com 1/15/2006 1:50:54 PM >>>
> >
> >At Tue, 19 Jun 2001, phillipsbill wrote:
> >>
> >>Does anyone have experience with reimbursement for 3D ultrasound?
> >
> >We have been billing the code for almost 3 years for Abd, OB/GYN, and
> >small parts with success however Aetna and Cigna insurance companies
> >are
> >not paying for the code. Aetna states that as of 4/1/06 they will
> >discontinue the new codes as they are incidental to the scan. Cigna
> >states that the 3D is still investigational.
> >
> >At the present one of our insurance companies is now requesting
> >repayment of the code for the past 2 years even though it was done in
> >conjunction with our regular code and not billed routinely for OB/GYN,
> >Abdominal, or small parts. We only bill when the images we obtain
> >give
> >us diagnostic value and we are fighting this request. If you have any
> >insight I would appreciate a response.
> >
> >Do you have any specific questions? Also do you have any experience
> >with
> >color flow billing?
> >
> >Thanks,
> >Rose
> >
>

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