OB/GYN Ultrasound CPT Codes
CPT® code, ultrasound, pregnant uterus, real time with image by a facility (e.g., CPT code TC) it should be billed using the date it was . is indicated regardless of gestational age, regardless of viability status. A viability scan is used to check a pregnancy is developing normally (is viable). It can be done transabdominally like a normal ultrasound after about 7 weeks. icd 10 code for pregnancy dating ultrasound cpt code for dating A viability scan is used to check a pregnancy is developing normally is viable.
The intra-class correlation coefficient ICC was highest for the vascular indices vascularization index VI and vascularization-flow index VFIgreater than 0. Intra-class correlation coefficient for flow index FI showed moderate correlation at 0. There was no bias between datasets.Introduction to Transvaginal Ultrasound Scanning-Part II
Prospective studies are now required to identify if this analysis tool and method is sensitive enough to recognise patients with early-onset placental dysfunction. More recently, 4-dimensional 4D or dynamic 3D scanners have come on the market, with the attraction of being able to look at fetal movements.
These have also been referred to as "reassurance scans" or "entertainment scans. However, the impact of 4D scans on diagnosis and management of fetal abnormalities is unknown. Three-dimensional ultrasound appears to have been useful in research on fetal embryology.
However, there is no evidence that the results of 3D ultrasound alters clinical management over standard 2D ultrasound such that clinical outcomes are improved. Whether 3D ultrasound will provide unique, clinically relevant information remains to be seen.
Despite these technical advantages, proof of a clinical advantage of 3-dimensional ultrasonography in prenatal diagnosis in general is still lacking. Potential areas of promise include fetal facial anomalies, neural tube defects, and skeletal malformations where 3-dimensional ultrasonography may be helpful in diagnosis as an adjunct to, but not a replacement for, 2-dimensional ultrasonography. Until clinical evidence shows a clear advantage to conventional 2-dimensional ultrasonography, 3-dimensional ultrasonography is not considered a required modality at this time.
Their use in fetal medicine varies with the nature of the tissue to be imaged and the challenges each organ system presents, versus the advantages of each ultrasound application. Fetal applications include all types of anatomical assessment, morphometry and volumetry, as well as functional assessment.
They had successful fetal nasal bone measurement by 2D US by 4 operators. Three-dimensional volumes were recorded in the mid-sagittal plane of fetal profile by the 5th operator and examined using multi-planar techniques.
In the subsequent 3D examination, the nasal bone length could be examined in 94 cases The mean difference between the 2D and 3D measurements was 0. Limits of agreement were The authors concluded that there was significant inter-method difference between the results obtained by 2D and 3D, as well as substantial inter-observer variation in 3D measurement of fetal nasal bone length in the 1st trimester.
They stated that independent 3D measurement of nasal bone offers no additional advantages over 2D US. Kurjak and colleagues stated that an evolving challenge for obstetricians is to better define normal and abnormal fetal neurological function in utero in order to better predict ante-natally which fetuses are at risk for adverse neurological outcome.
In a multi-center study, these investigators examined the use of 4D US in the assessment of fetal neurobehavior in high-risk pregnancies. It was revealed that fetuses were neurologically normal, 7 abnormal and 25 borderline. Out of 7 abnormal fetuses ATNAT was borderline in 5 and abnormal in 2, whereas GM assessment was abnormal in 5 and definitely abnormal in 2. In summary, out of 32 borderline and abnormal fetuses, ATNAT was normal in 7, borderline in 22 and abnormal in 3; GM assessment was normal optimal in 4, normal suboptimal in 20, abnormal in 6 and definitely abnormal in 2.
Ultrasound for Pregnancy - Medical Clinical Policy Bulletins | Aetna
The authors concluded that 4D US requires further studies before being recommended for wider clinical practice. The parents and families could readily understand the fetal conditions and undergo counseling; they then choose the option of termination of pregnancy. In a pilot study, Antsaklis et al evaluated the use of 3D ultrasonography as an alternative for examining fetal anatomy and nuchal translucency NT in the first trimester of pregnancy.
A total of low-risk pregnant women undergoing 1st trimester ultrasound scan for fetal anomalies were included in this study. The NT and fetal anatomy were evaluated by 3D ultrasonography after the standard 2D examination. The gold standard in this study was the 2D ultrasonography.
In some of the evaluated parameters, the 3D method approaches the conventional 2D results. These parameters are the crown-rump length CRLthe skull-brain anatomy Some of the anatomic parameters under evaluation revealed a statistically significant difference in favor of the 2D examination.
During the 3D examination the nasal bone was identified in The authors concluded that the 3D ultrasound is insufficient for the detailed fetal anatomy examination during the 1st trimester of pregnancy. An UpToDate review on "Idiopathic pulmonary hemosiderosis" Milman, does not mention the use of detailed ultrasound fetal anatomic examination.
According to the Product Insert of Keppra Pregnancy Category Cthere are no adequate and well-controlled studies in pregnant women. In animal studies, levetiracetam produced evidence of developmental toxicity, including teratogenic effects, at doses similar to or greater than human therapeutic doses. Keppra should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
As with other anti-epileptic drugs, physiological changes during pregnancy may affect levetiracetam concentration. There have been reports of decreased levetiracetam concentration during pregnancy. Discontinuation of anti-epileptic treatments may result in disease worsening, which can be harmful to the mother and the fetus.
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 total of 57 fetuses at high-risk for cleft palate were referred to specialist for ultrasonography at 12 to 40 weeks' gestation. 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 Mean gestational age at the first visit was 27 weeks 6 days range of 12 to 40 weeks 3 days. 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.
Better clinical documentation leads to better coding for OB ultrasounds
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.
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.
All the newborn infants underwent pediatric follow-up and were considered normal up to 2 years of life. 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.
Ultrasound for Pregnancy
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.
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