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CBHPM Questions and Answers

THE CBR Bulletin This month interviews Dr. Miyuki Goto, advisor to the Professional Defense Board of the Brazilian Medical Association (AMB), who clarifies doubts about the Brazilian Hierarchical Classification of Medical Procedures (CBHPM). Check it out below:

 

CBR Bulletin - Surface structure ultrasound code 4.09.01.21-1 includes axillary ultrasound. When underarm ultrasound is required, should the charge be one code or two because they are two armpits?

Dr. Miyuki Goto - This is an emblematic example, because the description leads to doubt. However, the informative incidence may elucidate that it refers to an amount for each side of the armpit:

- 4.09.01.21-1: Ultrasonography of superficial structures (cervical or axilla or muscle or tendon)

- Size 2A - Operating Cost 3.420 - Movie 0.1700 - Incidence 1

Thus, if performed on both armpits, it fits the quantity 2 (two).

 

CBR Bulletin - Does code 4.09.01.57-2 include Doppler payment? If liver Doppler total abdominal ultrasound is required (codes 4.09.01.12-2 and 4.09.01.38-6), can these codes be replaced by 4.09.01.57-2?

Dr. Miyuki Goto - Code TUSS 4.09.01.57-2 does not appear in CBHPM, so the valuation should be negotiated between the parties, considering the related exams:

- 4.09.01.57-2: Doppler ultrasound of the total abdomen and female pelvis - Yes - Total abdomen ultrasound

- 4.09.01.57-2: Doppler ultrasound of the total abdomen and female pelvis - Yes - Color Doppler of organs or structures (includes heart)

For current CBHPM, for total abdominal ultrasound with liver Doppler, the following codes should be used:

- 4.09.01.12-2: Ultrasound of the total abdomen (upper abdomen, kidneys, bladder, aorta, inferior vena cava and adrenals) - 3A 5,850 0,6800 4

- 4.09.01.38-6: Isolated organ or structure color Doppler - 3B 7.390 0.5100 3

 

CBR Bulletin - Does the total abdomen ultrasound code (4.09.01.12-2) include female or male pelvic ultrasound?

Dr. Miyuki Goto - No, even if you have a bladder in common.

 

CBR Bulletin - Does the total abdomen ultrasound code (4.09.01.12-2) include urinary tract ultrasound?

Dr. Miyuki Goto - Yes.

 

CBR Bulletin - Can the morphological ultrasound code (4.09.01.26-2) be charged above 24 weeks of gestation when fetal malformation is warranted?

Dr. Miyuki Goto - For the purposes of minimum coverage under the current ANS plan and Roll Usage Guidelines, do not:

- 75. Morphological obstetric ultrasound

  1. Mandatory coverage for pregnant women between 18 weeks and 24 weeks of gestation at the time of application for authorization of the procedure and when application for authorization of the procedure occurs up to the gestational age of 24 weeks.

The new ANS 2018 Roll Utilization Directive maintains the same description.

 

CBR Bulletin - Can all codes referring to obstetric ultrasound be charged per fetus if the pregnancy is two or more fetuses?

Dr. Miyuki Goto - Yes, except for the codes below which are provided for single and multiple pregnancies?

4.09.01.23-8: Obstetric Ultrasound - 2A 2.650 0.1700 1

4.09.01.27-0: Obstetric ultrasound in multiple pregnancy - each fetus - 1C 1.520 0.1700 1

4.09.01.24-6: Obstetric ultrasound with Doppler colored - 3A 6.270 0.5100 3

4.09.01.28-9: Obstetric ultrasound in multiple pregnancy with Doppler colorful - each fetus - 2B 3,250 0.1700 1

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Thiago Braga

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