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Coding and billing for transvaginal ultrasound to assess second-trimester cervical length

An SMFM consult


Transvaginal ultrasound cervical length (TVU CL) assessment is a safe, acceptable, reproducible, and accurate screening test, with potentially widespread availability. However, both proponents and opponents of universal cervical length (CL) screening for increased prematurity risk raise valid issues. Cervical length screening for singleton gestations with or without a prior history of preterm birth is a reasonable strategy. Therefore, implementation of routine second-trimester TVU CL can be a reasonable screening method considered by individual practitioners. Third-party payers should not deny reimbursements for this screening.1

Technique

Sonographic assessment of CL should be performed only by individuals trained in the technique. A TVU CL assessment needs to be performed with proper technique, quality control, and monitoring to yield accurate results. To ensure quality, the Perinatal Quality Foundation2 convened a cervix education task force in November 2011. The goal of the task force was to develop a consensus educational program that presented in a widely available format the standard criteria for sonographic CL measurements during pregnancy. The Cervical Length Education and Review (CLEAR) program is a product of the task force discussions. The CLEAR program provides 3 lectures, an optional examination, and a scored cervical image review. The lectures are available at no charge. Documentation of completion of the CLEAR program, as well as continuing medical education (CME) credits, will be provided to those who complete the lectures and pass the examination and the image review. More information is available at CLEAR: Cervical Length Education and Review (www.perinatalquality.org/CLEAR).3

When performed in low-risk, asymptomatic women for purposes of preterm birth (PTB) screening, a single TVU CL determination obtained between about 18 weeks’ and 24 weeks’ gestation is sufficient. Serial cervical exams are usually not indicated in low-risk women, but they are appropriate in high-risk pregnancies (ie, singleton gestations with prior PTB). Given reports that 57% of short CL on TVU are not detected on transabdominal ultrasound,4 and that the TVU screening approach was the one used in all published trials, TVU is the preferred approach for diagnosing cervical shortening. In recognition of the potential value of routine CL screening and the additional technical and time requirements needed to accomplish this assessment, payment for a single TVU examination performed between 18 and 24 weeks’ gestation for CL assessment in low-risk patients (ie, singleton gestations without prior PTB) is appropriate. When screening high-risk patients, a series of TVU CL measurements can be performed every 2 weeks between 16 and 24 weeks.5

 

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