Main -> Dating -> Ultrasound for Pregnancy - Medical Clinical Policy Bulletins . Aetna

Ultrasound for Pregnancy - Medical Clinical Policy Bulletins . Aetna

Baby's First Ultrasound! 6 Weeks Pregnant

Aetna considers ultrasounds not medically necessary if done solely to determine the fetal sex or to provide parents with a view and photograph of the fetus. Aetna considers detailed ultrasound fetal anatomic examination experimental and investigational for all other indications including routine evaluation of pregnant women who are on bupropion Wellbutrin or levetiracetam Keppra , pregnant women with low pregnancy-associated plasma protein A, and pregnant women who smoke or abuse cannabis. There is inadequate evidence of the clinical utility of detailed ultrasound fetal anatomic examination for indications other than evaluation of suspected fetal anatomic abnormalities. Detailed ultrasound fetal anatomic examination is not considered medically necessary for routine screening of normal pregnancy, or in the setting of maternal idiopathic pulmonary hemosiderosis. Ultrasonography in pregnancy should be performed only when there is a valid medical indication. ACOG stated, "The use of either two-dimensional or three-dimensional ultrasonography only to view the fetus, obtain a picture of the fetus, or determine the fetal sex without a medical indication is inappropriate and contrary to responsible medical practice.

In a Cochrane review, Grivell et al noted that policies and protocols for fetal surveillance in the pregnancy where impaired fetal growth is suspected vary widely, with numerous combinations of different surveillance methods. These researchers evaluated the effects of ante-natal fetal surveillance regimens on important peri-natal and maternal outcomes.

Randomized and quasi-randomized trials comparing the effects of described ante-natal fetal surveillance regimens were selected for analysis. Review authors independently assessed trial eligibility and quality and extracted data. They included 1 trial of women and their babies. This trial was a pilot study recruiting alongside another study, therefore, a separate sample size was not calculated.

The trial compared a twice-weekly surveillance regimen biophysical profile, non-stress tests, umbilical artery and middle cerebral artery Doppler and uterine artery Doppler with the same regimen applied fortnightly both groups had growth assessed fortnightly. There were insufficient data to assess this review's primary infant outcome of composite peri-natal mortality and serious morbidity although there were no peri-natal deaths and no difference was seen in the primary maternal outcome of emergency caesarean section for fetal distress risk ratio RR 0.

In keeping with the more frequent monitoring, mean gestational age at birth was 4 days less for the twice-weekly surveillance group compared with the fortnightly surveillance group mean difference MD The authors concluded that there is limited evidence from randomized controlled trials to inform best practice for fetal surveillance regimens when caring for women with pregnancies affected by impaired fetal growth. They stated that more studies are needed to evaluate the effects of currently used fetal surveillance regimens in impaired fetal growth.

A choroid plexus cyst is a small fluid-filled structure within the choroid of the lateral ventricles of the fetal brain. According to the Society for Maternal-Fetal Medicine SMFM,when a choroid plexus cyst is identified, the presence of structural malformations and other sonographic markers of aneuploidy should be assessed with a detailed fetal anatomic survey performed by an experienced provider. If no other sonographic abnormalities are present, the choroid plexus cyst is considered isolated.

Gindes et al evaluated the ability of 3D ultrasound for demonstrating the palate of fetuses at high-risk for cleft palate. A detailed assessment of palate was made using both 2D and 3D ultrasounds on the axial plane. Antenatal diagnoses were compared with post-natal findings.

Cleft palate was suspected in 13 Sensitivity, specificity, positive-predictive value, and negative-predictive value of detection of palatal clefts were Kanenishi et al evaluated the frequency of fetal facial expressions at 25 to 27 weeks of gestation using 4D ultrasound.

A total of 24 normal fetuses were examined using 4D ultrasound.

The face of each fetus was recorded continuously for 15 mins. The frequencies of tongue expulsion, yawning, sucking, mouthing, blinking, scowling, and smiling were assessed and compared with those observed at 28 to 34 weeks of gestation in a previous study.

The authors concluded that the results indicated that facial expressions can be used as an indicator of normal fetal neurologic development from the 2nd to the 3rd trimester. They stated that 4D ultrasound may be a valuable tool for assessing fetal neurobehavioral development during gestation.

Baby's First Ultrasound! 6 Weeks Pregnant

These preliminary findings need to be validated by well-designed studies. Votino et al evaluated prospectively the use of 4D spatio-temporal image correlation STIC in the evaluation of the fetal heart at 11 to 14 weeks' gestation. The study involved off-line analysis of 4D-STIC volumes of the fetal heart acquired at 11 to 14 weeks' gestation in a population at high-risk for congenital heart disease CHD.

Regression analysis was used to investigate the effect of gestational age, maternal body mass index, quality of the 4D-STIC volume, use of a trans-vaginal versus trans-abdominal probe and use of color Doppler ultrasonography on the ability to visualize separately different heart structures.

A total of fetuses with a total of STIC volumes were included in this study. Regression analysis showed that the ability to visualize different heart structures was correlated with the quality of the acquired 4D-STIC volumes. Independently, the use of a trans-vaginal approach improved visualization of the 4-chamber view, and the use of Doppler improved visualization of the outflow tracts, aortic arch and inter-ventricular septum.

Follow-up was available in of the fetuses, of which 27 had a confirmed CHD. Early fetal echocardiography using 2D ultrasound was possible in all fetuses, and accuracy in diagnosing CHD was The authors concluded that in fetuses at 11 to 14 weeks' gestation, the heart can be evaluated offline using 4D-STIC in a large number of cases, and this evaluation is more successful the higher the quality of the acquired volume.

Moreover, they stated that 2D ultrasound remains superior to 4D-STIC at 11 to 14 weeks, unless volumes of good to high quality can be obtained. Ahmed stated that CHD is the commonest congenital anomaly. It is much more common than chromosomal malformations and spinal defects.

Its' estimated incidence is about 4 to 13 per 1, live births. Congenital heart disease is a significant cause of fetal mortality and morbidity. Antenatal diagnosis of CHD is extremely difficult and requires extensive training and expertise. Spatio-temporal image correlation is an automated device incorporated into the ultrasound probe and has the capacity to perform slow sweep to acquire a single 3D volume.

This acquired volume is composed of a great number of 2D frames. This volume can be analyzed and re-analyzed as required to demonstrate all the required cardiac views.

It also provides the examiner with the ability to review all images in a looped cine sequence. The author concluded that this technology has the ability to improve the ability to examine the fetal heart in the acquired volume and decrease examination time; it is a promising tool for the future.

Tonni et al described the application of a novel 3D ultrasound reconstructing technique OMNIVIEW that may facilitate the evaluation of cerebral midline structures at the 2nd trimester anatomy scan. Fetal cerebral midline structures from consecutive normal low-risk pregnant women were studied prospectively by 2D and 3D ultrasound between 19 to 23 weeks of gestation.

In addition, 5 confirmed pathologic cases were evaluated and the abnormal features using this technique were described in this clinical series. Off-line volume data sets displaying the corpus callosum and the cerebellar vermis anatomy were accurately reconstructed in For pathological cases, an agreement rate of 0. The authors concluded that this study demonstrated the feasibility of including 3D ultrasound as an adjunct technique for the evaluation of cerebral midline structures in the 2nd trimester fetus.

Moreover, they stated that future prospective studies are needed to evaluate if the application of this novel 3D reconstructing technique as a step forward following 2D second trimester screening scan will improve the prenatal detection of cerebral midline anomalies in the low-risk pregnant population. Sharp et al noted that fetal assessment following PPROM may result in earlier delivery due to earlier detection of fetal compromise. However, early delivery may not always be in the fetal or maternal interest, and the effectiveness of different fetal assessment methods in improving neonatal and maternal outcomes is uncertain.

In a Cochrane review, these researchers examined the effectiveness of fetal assessment methods for improving neonatal and maternal outcomes in PPROM. Examples of fetal assessment methods that would be eligible for inclusion in this review include fetal cardiotocography, fetal movement counting and Doppler ultrasound. Randomized controlled trials RCTs comparing any fetal assessment methods, or comparing one fetal assessment method to no assessment were selected for analysis.

Two review authors independently assessed trials for inclusion into the review. The same 2 review authors independently assessed trial quality and independently extracted data.

Data were checked for accuracy. These researchers included 3 studies involving women data reported for with PPROM at up to 34 weeks' gestation. All 3 studies were conducted in the United States. Each study investigated different methods of fetal assessment. These investigators were unable to perform a meta-analysis, but were able to report data from individual studies.

There was no convincing evidence of increased risk of neonatal death in the group receiving endovaginal ultrasound scans compared with the group receiving no assessment risk ratio RR 7. For both these interventions, these researchers inferred that there were no fetal deaths in the intervention or control groups. The study comparing daily non-stress testing with daily modified biophysical profiling did not report fetal or neonatal death. Primary outcomes of maternal death and serious maternal morbidity were not reported in any study.

Dating ultrasound cpt

Overall, there were few statistically significant differences in outcomes between the comparisons. The overall quality of evidence was poor, because participant blinding was not possible for any study. The authors concluded that there is insufficient evidence on the benefits and harms of fetal assessment methods for improving neonatal and maternal outcomes in women with PPROM to draw firm conclusions.

The overall quality of evidence that does exist is poor. They stated that further high-quality RCTs are needed to guide clinical practice.

In a Cochrane review, Alfirevic et al examined the effects on obstetric practice and pregnancy outcome of routine fetal and umbilical Doppler ultrasound in unselected and low-risk pregnancies. These investigators searched the Cochrane Pregnancy and Childbirth Group Trials Register February 28, and reference lists of retrieved studies. Randomized and quasi-randomized controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in unselected pregnancies compared with no Doppler ultrasound were selected for analysis.

Studies where uterine vessels have been assessed together with fetal and umbilical vessels have been included. Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. In addition to standard meta-analysis, the 2 primary outcomes and 5 of the secondary outcomes were assessed using GRADE software and methodology. These researchers included 5 trials that recruited 14, women, with data analyzed for 14, women. All trials had adequate allocation concealment, but none had adequate blinding of participants, staff or outcome assessors.

Overall and apart from lack of blinding, the risk of bias for the included trials was considered to be low. Overall, routine fetal and umbilical Doppler ultrasound examination in low-risk or unselected populations did not result in increased antenatal, obstetric and neonatal interventions.

There were no group differences noted for the review's primary outcomes of perinatal death and neonatal morbidity. Results for perinatal death were as follows: average RR 0. Only 1 included trial assessed serious neonatal morbidity and found no evidence of group differences RR 0. For the comparison of a single Doppler assessment versus no Doppler, evidence for group differences in perinatal death was detected RR 0.

However, these results are based on a single trial, and these researchers would recommend caution when interpreting this finding. There was no evidence of group differences for the outcomes of caesarean section, neonatal intensive care admissions or preterm birth of less than 37 weeks.

Evidence for admission to neonatal intensive care unit was assessed as of moderate quality, and evidence for the outcomes of caesarean section and preterm birth of less than 37 weeks was graded as of high quality.

There was no available evidence to assess the effect on substantive long-term outcomes such as childhood neurodevelopment and no data to assess maternal outcomes, particularly maternal satisfaction.

The authors concluded that existing evidence does not provide conclusive evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations benefits either mother or baby. They stated that future studies should be designed to address small changes in perinatal outcome, and should focus on potentially preventable deaths. In a Cochrane review, Bricker et al evaluated the effects on obstetric practice and pregnancy outcome of routine late pregnancy ultrasound, defined as greater than 24 weeks' gestation, in women with either unselected or low-risk pregnancies.

These investigators searched the Cochrane Pregnancy and Childbirth Group's Trials Register May 31, and reference lists of retrieved studies. All acceptably controlled trials of routine ultrasound in late pregnancy defined as after 24 weeks were selected for analysis. Three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

A total of 13 trials recruiting 34, women were included in the systematic review.

Risk of bias was low for allocation concealment and selective reporting, unclear for random sequence generation and incomplete outcome data and high for blinding of both outcome assessment and participants and personnel. There was no difference in ante-natal, obstetric and neonatal outcome or morbidity in screened versus control groups. Routine late pregnancy ultrasound was not associated with improvements in overall perinatal mortality.

There is little information on long-term substantive outcomes such as neurodevelopment. There is a lack of data on maternal psychological effects. Overall, the evidence for the primary outcomes of perinatal mortality, pre-term birth of less than 37 weeks, induction of labor and caesarean section were assessed to be of moderate or high quality with GRADE software.

There was no association between ultrasound in late pregnancy and perinatal mortality RR 1. Because none of the included studies reported these outcomes, they were not assessed for quality with GRADE software. The authors concluded that based on existing evidence, routine late pregnancy ultrasound in low-risk or unselected populations did not confer benefit on mother or baby.

Ultrasound Orders/CPT codes. CPT Codes and Description NT Singleton Order both and if no prior OB ultrasound same ultrasound lab. Pregnancy dating with a first trimester or mid-trimester ultrasound will reduce the CPT when a patient is seen by another maternal-fetal medicine. Pregnancy dating with a first trimester or mid-trimester ultrasound will reduce the Follow-up ultrasound for CPT should be CPT when doing a.

There was no difference in the primary outcomes of perinatal mortality, pre-term birth of less than 37 weeks, caesarean section rates, and induction of labor rates if ultrasound in late pregnancy was performed routinely versus not performed routinely.

Meanwhile, data were lacking for the other primary outcomes: pre-term birth of less than 34 weeks, maternal psychological effects, and neurodevelopment at age 2, reflecting a paucity of research covering these outcomes.

Obstetrical (OB) ultrasound studies must be well documented in order to support the CPT® code(s) chosen. The CPT code book lists the. plans (for Date of Service (DOS) prior to 01/01/17, NJ School . ultrasound CPT codes; precertification for the fourth and subsequent procedure. FirstCare considers one complete fetal anatomic scan (CPT®. ) Reimburse once, regardless of the number of fetuses, and only once per date of service.

The authors stated that these outcomes may warrant future research. The Zika virus is a mosquito-borne virus that has been associated with congenital defects, primarily of the central nervous system SMFM, According to the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, clinicians should screen pregnant women for possible Zika exposure, particularly if living or traveled to areas of active Zika transmission.

Pregnant women exposed to Zika or who report clinical illness consistent with the virus should be tested for the virus based on national guidelines. Part of that testing involves fetal ultrasound to detect microcephaly or intracranial calcifications, and in certain cases, amniocentesis may be offered SMFM, Bellussi and colleagues noted that fetal mal-positions and cephalic mal-presentations are well-recognized causes of failure to progress in labor. They frequently require operative delivery, and are associated with an increased probability of fetal and maternal complications.

Traditional obstetrics emphasizes the role of digital examinations, but recent studies demonstrated that this approach is inaccurate and intra-partum US is far more precise. These investigators summarized the available evidence and provided recommendations to identify mal-positions and cephalic mal-presentations with US.

These researchers proposed a systematic approach consisting of a combination of trans-abdominal and trans-perineal scans and described the findings that allow an accurate diagnosis of normal and abnormal position, flexion, and synclitism of the fetal head.

The management of mal-positions and cephalic mal-presentation is currently a matter of debate, and individualized depending on the general clinical picture and expertise of the provider. The authors concluded that intra-partum US allows a precise diagnosis and thus offers the best opportunity to design prospective studies with the aim of establishing evidence-based treatment. Castro and associates determined the diagnostic accuracy of US to detect deep-vein thrombosis DVT in pregnant patients.

The reference lists of the included studies were analyzed.

ACR Radiology Coding Source March-April 2007

Original articles from accuracy studies that analyzed US to diagnose DVT in pregnant women were included. Reference standard was the follow-up time. Titles and summaries from 2, articles were identified; 4 studies that evaluated DVT in pregnant women were included; a total of participants were enrolled.

Aetna considers a fetal ultrasound with detailed anatomic examination medically . Significant discrepancy between uterine size and clinical dates (CPT ) is not necessary as a routine scan for all pregnancies (SMFM, ). Rather. Coding and billing for transvaginal ultrasound to assess second-trimester on the same date of service as a transabdominal ultrasound performed for other. Q Are CPT and different? Both are for fetal and maternal ultrasound evaluation, yet includes a detailed fetal anatomic exam. to 14 weeks, 0 days), check the patient record for gestation on the date of the scan to be sure.

Negative predictive value was The authors concluded that accuracy of US to diagnose DVT in pregnant women was not determined due to the absence of data yielding positive results.

They stated that further studies of low risk of bias are needed to determine the diagnostic accuracy of US in this clinical scenario. Depending on the extent of fusion, separation of the uterine horns will be complete, partial, or minimal. It is important to note that includes in its code description, "one or more fetuses," and should not be coded more than once per study, or per fetus. If a study is done to reassess fetal size, or to re-evaluate any fetal organ-system abnormality noted on a previous ultrasound study, is appropriate.

A biophysical profile consists of five elements — four of which are studied with ultrasound, and the fifth element, which involves a nonstress test usually administered by the patient's obstetrician. The four elements that are scored from an ultrasound study are amniotic fluid, breathing, gross body movements, and fine motor movements. Reporting of this score satisfies the required documentation of the study being performed. The fetus must be observed under ultrasound for a specified period of time to determine if the body movements are present.

Correct coding for the biophysical profile score of the four elements without nonstress testing is This code may be assigned as a stand-alone service, or may be assigned in addition to any other OB ultrasound study performed at the same encounter. Code is reported per fetus. A biophysical profile performed along with a nonstress test is coded A nonstress test performed without a biophysical profile is coded Doppler evaluation may be performed, and there are CPT codes in the OB ultrasound section for two sites: the umbilical cord,and the middle cerebral artery, This measurement would normally be done later in the pregnancy.

These codes may be assigned in addition to any other OB ultrasound study performed at the same encounter, and are reported per fetus. Smaller, office ultrasound machines cannot perform this detailed exam. A detailed examination is not warranted in every case just because the required machine is handy. The key to use of code is medical justification eg, a suspected fetal problem. Q If a patient is scanned both transvaginally and transabdominally in the first trimester, can I use both code and code ?

If the patient is less than 14 weeks, 0 days of gestation, and the documentation shows both a fetal and maternal evaluation, the correct code would be ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester [.

Make sure that there are 2 reports—1 for the abdominal and 1 for the vaginal scan—and that both are medically indicated. Also, since you are doing multiple scans in 1 encounter, add a modifier multiple procedure to the code with the lower relative value. Which code takes modifier? It depends on whether you bill for the professional and technical components you own the machine or just the professional part physician provides the interpretation and report onlybecause the 3 relative-value components assigned to each code add up differently.

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