The authors concluded that ophthalmic artery Doppler is a simple, accurate and objective technique with a standalone predictive value for the development of early-onset PE equivalent to that of uterine artery Doppler evaluation. ins.dataset.fullWidthResponsive = 'true'; Growth disturbances: Risk of intrauterine growth restriction. Johnson TR, Paine LL, Strobino DM, et al. Health Technol Assess. Clinical Information Cpt 26260 is a surgical, Read More CPT Code 26260 | Description & Clinical InformationContinue, CPT 78191 describes the re-transfusion of a patients tagged platelets, which have been studied for their lifespan after a blood sample is taken. Am J Obstet Gynecol. There were statistically significant differences in uterine artery pulsatility index (UtA-PI) and ophthalmic artery first diastolic peak (PD1) mean values between the PE and control groups. The combination of the PAPP-A level and the 2nd trimester sFlt-1/PlGF ratio yielded a DR of 87.5 % at a fixed FPR of 5 %, the combination of 2nd and 3rd trimester sFlt-1/PlGF ratios yielded a DR of 87.5 % at a fixed FPR of 10 %, the combination of BMI and the 2nd trimester sFlt-1 level yielded a DR of 87.5 % at a fixed FPR of 10 %, the combination of the PAPP-A and inhibin-A levels yielded a DR of 50 % at a fixed FPR of 10 %, and the combination of the PAPP-A level and the 3rd trimester sFlt-1/PlGF ratio yielded a DR of 62.5 % at a fixed FPR of 10 %. Although some prospective studies and trials demonstrated that angiogenic markers have a high negative predictive value and thus can be useful in ruling out preeclampsia and reducing the time to diagnosis, the value of early accurate diagnosis alone without a concomitant improvement in maternal and/or neonatal outcome is questionable. Prediction of preeclampsia. Only one antepartum care code is allowed to be billed per pregnancy. Of 2,532 studies reviewed, 12 met the criteria for inclusion; 6 reported that prenatal stress significantly affected maternal or fetal hemodynamics; 6 found no significant association between maternal stress and circulation. Non-global OB care. The new Maternity Services policy has the same reimbursement guidelines for global billing as the current Routine Obstetrics policy with an update to the postpartum period. Ultrasound Obstet Gynecol. Other Manuals. After adjusting for confounding variables, only PMDV remained statistically significant (p<0.001), with an area under the receiver-operating characteristics curve (AUC) of 0.73. The medical billing code 59025 means fetal non-stress test. Because observation may span multiple calendar dates you might be wondering how is this billed following line item billing guidelines? Ultrasound Obstet Gynecol. The difference was significant in early-onset pre-eclamptic women (p<0.05) rather than late-onset pre-eclamptic ones (p>0.05). 2019 53(4):465-472. How should [], Copyright 2023. Median ADAM12 levels were significantly lower in patients who developed PE compared to those who did not (0.81 versus 1.01 MoM; p = 0.04). A recently published meta-analysis of 20 controlled trials of Doppler ultrasonography found, however, that there is "compelling evidence" that knowledge of the Doppler findings improved perinatal outcome in high-risk pregnancies, reducing antenatal admissions, inductions of labor, and cesarean sections for fetal distress, and reducing the odds of perinatal death by 38 %.". In this situation, you should include labor checks in the hospital admission fee (99221-99223), Sherland says. Statistically, uterine artery PI, RI, radial artery PI, spiral artery PI, and RI were also significantly lower in patients with malign histopathology. For 4 to 6 visits: Use CPT 59425, This code must not be billed by the same, provider in conjunction with one to three office visits, or in conjunction with, For 7 or more visits: Use CPT 59426 Complete antepartum care is limited to, A single claim submission of CPT code 59425 or 59426 for the antepartum care, only, excluding the confirmatory visit that may be reported and separately. Together, these 3 biochemical markers are intended to contribute to accurate prediction of risk for early onset preeclampsia. ACOG Practice Bulletin No. In a Cochrane review, Alfirevic and colleagues (2010)evaluated the effects on obstetric practice and pregnancy outcome of routine fetal and umbilical Doppler ultrasound in unselected and low-risk pregnancies. 2013;32(9):1593-1600. li.bullet { Norwitz ER. 02-E018. Eur J Obstet Gynecol Reprod Biol. Angiogenic factors in pregnancies of women with antiphospholipid syndrome and systemic lupus erythematosus. Discordant fetal growth is common in multiple gestation and usually is defined by a 15 to 25 % reduction in the estimated fetal weight of the smaller fetus when compared with the largest. 59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care. Fetal movement assessment. The normotensive and pre-eclamptic groups were compared using parametric (Student's t-test) and non-parametric (Mann-Whitney U-test) tests. 2016;47(1):22-27. Furthermore, an UpToDate review on Preeclampsia: Clinical features and diagnosis (August and Sibai, 2021) does not recommend screening of placental growth factor (PIGF) as a management tool. 2. The following CPT codes are used for delivery and postpartum care only services, Vaginal delivery only(with or without episiotomy and/or forceps); including postpartum care, Cesarean delivery only; including post partum care, Vaginal delivery only, after previous cesarean delivery (with or without, Cesarean delivery only, following attempted vaginal delivery after, Hospital visits related to the delivery during the delivery confinement, Uncomplicated out patient visits related to the pregnancy. Additional history was obtained through participant questionnaires, and follow-up occurred to discharge post-delivery. Additionally, the AUC increased significantly from 0.82 to 0.88 when the PMDV was incorporated into the model containing clinical variables and UtA Doppler indices. Not only are Doppler velocimetry findings normal in growth-restricted fetuses with chromosomal or other structural etiologies but Doppler velocimetry has been shown to both reduce interventions and improve fetal outcome in pregnancies at risk for IUGR. Modified BPP combines the NST (with the option of acoustic stimulation), as a short-term indicator of fetal acid-base status, with the amniotic fluid index as an indicator of long-term placental function. Next, the patient's back is raised, and the provider attaches two belts to the mother's abdomen. Author . 86003. Duan and colleagues (2017) noted that identifying women at risk of PE by maternal serum screening is conducive to prompt gestational management and thereby improve both maternal and perinatal outcomes. 2001;184(6):1251-1255. If the baby's heart rate still does not accelerate, the ob-gyn will determine this to be a -nonreactive- NST. } All included studies had clear description of the index and reference tests, avoidance of verification bias and adequate follow-up. The use of sFlt-1/PIGF ratio combined with the baseline model significantly improved the area under the curve values for predicting delivery within a week (0.83 versus 0.88; p = 0.025) or in 2 weeks (0.86 versus 0.93; p = 0.001) due to PE-related events in gestational ages of less than 35 weeks. A total of 6 articles were included in this meta-analysis. Studies where uterine vessels have been assessed together with fetal and umbilical vessels have been included. 1996;42(4):101-104. In this situation, you should include labor checks in the hospital admission fee (99221-99223), Sherland says. Washington, DC: ACOG; October 1999. Westergaard HB, Langhoff-Roos J, Lingman G, et al. text-decoration: underline; Overall, the test lasts 30-40 minutes, during which the ob-gyn monitors the fetal heart rate using external transducers. The consent submitted will only be used for data processing originating from this website. Lancet. Non-invasive 20-40 minutes to perform, fetus can be Ultrasonographic surveillance in red blood cell alloimmunization. Aetna considers umbilical artery Doppler velocimetry experimental and investigational for multiple gestations pregnancies, except in those conditions noted above,becauseits effectiveness for this indication has not been established. Overall, the test lasts 30-40 minutes, during which the ob-gyn monitors the fetal heart rate using external transducers. Reference ranges for Doppler indices of umbilical and fetal middle cerebral arteries and cerebroplacental ratio: Systematic review. Int J Gynaecol Obstet. A specifically designed data extraction form was used. If the clinical condition that has prompted testing persists, repeat testing (either weekly or twice-weekly, depending on the test used and the presence of certain high-risk conditions) is considered medically necessary until delivery. Manning F. Fetal assessment based on fetal biophysical profile scoring. National Coordinating Centre for Health Technology Assessment (NCCHTA). Did you report combo code 58152 rather than 51840? Gurgel Alves JA, Praciano de Sousa PC, Bezerra Maia E, et al. Ozcan T, Sbracia M, d'Ancona RL, et al. 1. The CPT book describes the 59025 CPT code as: Fetal non-stress test.. padding: 10px; CPT Code 0734T CPT 0734T describes remote real-time, motion-capture-based neurorehabilitative, Read More CPT Codes For Remote Body And Limb Kinematic Measurement-Based TherapyContinue, CPT 44140 describes a procedure in which the colon is divided and the two ends are rejoined. The ob-gyn may perform the labor check, but as long as the patient does not deliver within 24 hours of admittance, you can include the reimbursement for the labor check in your codes for initial hospital care (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ). Postpartum care after vaginal or cesarean section delivery (CPT code 59430). Simple removal of cerclage (not under anesthesia). The fee is reimbursed for all of the members obstetric care to one provider. ACOG Practice Bulletin No. Afterward, he tries an electronic larynx to stimulate the fetus with noise through the patient's abdomen. American College of Obstetricians and Gynecologists (ACOG), Committee on Practice Bulletins -- Obstetrics. The mean values for sFlt-1 were 1 247,11 545,84 pg/ml and 47,00 22,62 pg/ml for PlGF. 2017;75:6-15. .strikeThrough { color: blue!important; The PSV ratio also improved the prediction of PE with delivery at less than 3 weeks from assessment provided by maternal factors alone (from 31.0 % to 69.4% ), maternal factors plus MAP (74.1 % to 83.4 %), maternal factors, MAP plus UtA-PI (77.1 % to 85.0 %) and maternal factors, MAP plus PlGF (88.6 % to 90.7 %). Performance of screening was consistently lower in populations with risk factors for PE in the maternal history. Additional sources are used and can be provided upon request. } When the same group physician and/or other healthcare professional provides all components of the OB package, the appropriate CPT code for the Global OB care is reported. 1985;92:605-610. Apply for the Job in Medical Claims Processor at El Paso, TX. Obstet Gynecol. Goetzinger et al (2013) estimated the efficiency of first trimester Ut-A Doppler, ADAM12, PAPP-A, and maternal characteristics in the prediction of PE. 13. Ischemia-modified albumin in preterm infants born to mothers with pre-eclampsia. Ozdemir and associates (2018) stated that pre-eclampsia (PE) carries an increased risk for maternal and/or fetal mortality or serious morbidity; and PE is associated with ischemia and increased oxidative stress in the placenta, which may lead to modification of plasma albumin to ischemia-modified albumin (IMA). These researchersidentified eligible studies through Medline searches, and, for each included study,they assessed the risk of bias and extracted relevant data. Although meta-analyses show that uterine artery Doppler analysis can predict women at increased risk of preeclampsia, we and most experts do not recommend these studies for screening purposes. Norwitz ER, Bellussi F. Early pregnancy prediction of preeclampsia. In a prospective, first-trimester study, Allen and Aquilina (2018) examined the efficacy of biomarkers, arteriography and uterine artery Dopplers for predicting hypertensive disease of pregnancy, SGA and stillbirth. The mother marks the strip when she feels movement throughout the 30-40 minutes of the test. Am J Obstet Gynecol. necessity for these services. list-style-type : square !important; Non-global OB care, or partial services, refers to maternity care that is not managed by a single provider or group practice. Loss of reactivity is associated most commonly with the fetal sleep cycle but may result from any cause of central nervous system depression, including fetal acidosis and some medications. The magnitude of increase in accuracy was 7.9 % (-0.5 % to 16.4 %, posterior probability of increase: 96.7 %) for sFlt-1/PlGF ratio. Women assigned to antepartum umbilical artery Doppler velocimetry have been shown to require less frequent antenatal monitoring and shorter durations of maternal hospitalization. In a multi-parametric model, both UtA-PI and PD1 achieved a 67 % detection rate for early PE, although when combined, the detection rate only increased to 68 %. A provider could also bill the procedure with a -22 modifier in which an additional 50% could be Receiver operating characteristic curve analysis showed that the 3rd trimester sFlt-1/PlGF ratio yielded the best detection rate (DR) for PE at a fixed false-positive rate (FPR) of 10 %, followed by the 2nd trimester sFlt-1/PlGF ratio, sFlt-1 level, and PlGF level. Policy ProviderOne You file all claims through the ProviderOne portal. The diagnostic value of the Doppler ultrasonography in distinguishing the endometrial malignancies in women with postmenopausal bleeding. The review found that uterine artery Doppler screening of high-risk women (e.g., history of chronic hypertension or preeclampsia, prior fetal growth restriction, or stillbirth) with singleton gestations appears to identify those at substantially increased risk for adverse pregnancy outcomes (Scicioneand Hayes, 2009). Performance of first trimester biochemical markers and mean arterial pressure in prediction of early-onset pre-eclampsia. The total OB package is not provided to the patient by the same physician or group practice. Rates and Billing. To separately bill this service with 59025 (Fetal nonstress test), your ob-gyn must document a clear indication for doing the NST (for instance, to measure fetal wellbeing).You must have a report with the findings and a recommendation for further testing or treatment. Resolution: Billing of modifier 76 (repeat procedure or service by the same physician or other qualified health care professional) or 77 (repeat procedure or service by another physician or other qualified health care professional) should be used to report the performance of multiple diagnostic services on the same day if these were not actually YKL-40 exhibits growth factor activity for cells involved in tissue re-modeling processes; it may have a role in cancer cell proliferation, survival, and invasiveness, angiogenesis, and re-modeling of the extracellular matrix. There was no evidence of group differences for the outcomes of caesarean section, neonatal intensive care admissions or pre-term birth less than 37 weeks. To read the full article, sign in and subscribe to the AMA CPT Assistant. "The patient reports fetal movement as an external monitor records fetal heart rate changes. The methodological quality of included studies was assessed using well-accepted quality appraisal guidelines. The other 2 ophthalmic artery indices of first PSV and PI were not significantly affected by PE. Friedman SA, Lindheimer MD. Obstet Gynecol. Although awareness of fetal movements is associated with improved perinatal outcomes, the quest to define a quantitative "alarm limit" to define decreased fetal movements has so far been unsuccessful, and the use of most such limits developed for fetal movement counting should be discouraged. UA had sensitivity and specificity 70 % and 47.8 %, respectively, for most suitable cut-off value delta UA 16.7 %. The empirical results on DR at 10 % FPR were consistent with the modelled results. provider for the same beneficiary, during the same pregnancy. 7. Int J Gynaecol Obstet. American College of Obstetricians and Gynecologists (2000) guidelines on intra-uterine growth retardation (IUGR)reached the following conclusions about the clinical utility of Doppler ultrasound of the umbilical artery: "Although Doppler velocimetry of the umbilical arteries is not useful as a screening technique for IUGR, it has been demonstrated to be useful once IUGR has been diagnosed. Based on the readings from the transducer, the labor stops. Cindy Hughes is the coding and compliance specialist for the AAFP and is a contributing editor to Family Practice Management. Furthermore, frequency of antepartum testing and certain aspects of obstetric intervention are reduced with use of Doppler." 2014;93(8):817-824. Br J Obstet Gynaecol. Furthermore, ophthalmic artery Doppler indices were not adjusted for maternal factors such as alcohol consumption (although the rates of such factors were similar between cases and controls), and raw values rather than multiples of the median (MoM) were used in statistical analyses. Pediatr Int. 1997;9(4):271-286. The authorspresented encouraging results for the prediction of early PE, even in the first trimester of pregnancy. Ozcan T, Thornburg L, Mingione M, Pressman E. Use of middle cerebral artery peak systolic velocity and intrauterine transfusion for management of twin-twin transfusion and single fetal intrauterine demise. In the selected literature, a combination of these markers was analyzed, and where relevant, the value of maternal characteristics was added. A controlled trial of self-nonstress test versus assisted nonstress test in the evaluation of fetal well being. #closethis { Cochrane Database Syst Rev. Penning S, Garite TJ. An MUE for a Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) code is the maximum units of service that a provider would . Your email address will not be published. Next, the provider uses an external monitor to evaluate the fetus. The ob-gyn checks her and sees that she's dilated 3 cm. 2015;9:13-20. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. They had a higher incidence of Ut-A Doppler bilateral notching, higher mean Ut-A Doppler-PI z-scores (p < 0.001) and UA PI z-scores (p = 0.03), but no significant difference in DV-PI z-scores or in the incidence of abnormal qualitative UA and DV patterns. Modifier 59 should be used when the injection is a separate service from other treatments. Maternal uterine artery and ophthalmic artery Doppler assessments were performed in 440 singleton pregnancies at 11 to 14weeks of gestation. When you report 59025 (Fetal non-stress test) for NST procedures, make sure you-re reporting them in the appropriate situations. Fetuses with normal flow patterns seem less likely to benefit from consideration of early delivery than do their counterparts with abnormal studies.". NST Procedure Code 59025 Components of a NST - V i biliVariability Short term variability (STV) . Umbilical artery Doppler velocimetry has not been shown to impact other perinatal outcomes, such as gestational age at birth, birth-weight, Apgar scores, and cesarean birth rates. Serum YKL-40 and apelin concentrations were measured. Systolic blood pressure (SBP) in the aorta (SBPAO) (p=0.002) was significantly associated with PE. An example of data being processed may be a unique identifier stored in a cookie. } A patient has the delivery performed . Summary of randomized and quasi-randomized studies indicated that, among high-risk pregnancies with suspected IUGR, the use of umbilical arterial Doppler assessment significantly decreases the likelihood of labor induction, cesarean delivery, and perinatal deaths (1.2 % versus 1.7 %; relative risk, 0.71; 95 % confidence interval: 0.52 to 0.98). Insertion of cervical dilator on same date as delivery (CPT code 59200). The pulsatility index of the ophthalmic artery did not show a clinically useful sensitivity or specificity at any cut-off for early- or late-onset PE. The first diastolic peak velocity had a much lower sensitivity (39.0 %; 95 % CI: 20.6 to 61.0 %), a similar specificity (73.2 %; 95 % CI: 66.9 to 78.7 %) and a lower AUC (0.58; 95 % CI: 0.52 to 0.65) for the prediction of late-onset PE. The authors concluded that blood flow of uterine artery and also myometrial and endometrial vasculature displayed lower impedance in patients with malignant endometrium, but these lower indices are not already adequate for using as diagnostic tests. Cord IMA was significantly increased in all preterm neonates in the PE group compared with the control group. Thus, once IUGR is suspected or diagnosed, Doppler velocimetry may be useful as a part of fetal evaluation. Patients with a pre-existent diabetes mellitus had significantly low sFlt-1 and PlGF (p < 0.05) values. A Cochrane review on BPP for fetal assessment in high-risk pregnancies (Lalor et al, 2008) concluded that there is currently insufficient evidence from randomized trials to support the use of BPP as a test of fetal wellbeing in high-risk pregnancies. Two authors independently assessed the studies for inclusion, assessed risk of bias, as well ascarried out data extraction. Obstet Gynecol Surv. Accordingly, another cohort would be needed to validate the new model. Comparison of the modified biophysical profile to a 'new' biophysical profile incorporating the middle cerebral artery to umbilical artery velocity flow systolic/diastolic ratio. Services Excluded from the Global Obstetrical Package, The following services are excluded from the global OB package (CPT codes 59400, 59510, 59610, and 59618). Moreover, they stated that despite the statistical association with Ut-A Doppler first trimester SGA prediction is poor and not improved by the incorporation of fetal Doppler. Obstet Gynecol Clin N Am. In a systematic review, Kuc et al (2011) examined the literature on the predictive potential of first-trimester serum markers and of UAD velocity waveform assessment (uterine artery [Ut-A] Doppler). Claims submitted with modifier -22 must include medical record documentation that supports the use of the modifier. For Vaginal Deliveries Bill vaginal deliveries for multiples using the guidelines outlined below: For the first infant (Baby A): This observation provides the rationale for fetal movement assessment by the mother ("kick counts") as a means of antepartum fetal surveillance. Am J Obstet Gynecol. Because the ob-gyn uses the fetal monitor to assess the mother and not fetal well-being, you should include this test as part of the labor check, which would be part of the global ob package (such as 59400).Best bet: -When a patient comes in and is hooked up to the monitor, and the ob-gyn determines the patient is in labor, we generally do not code this service,- Engstrom says. A CST or full BPP is considered medically necessary following an abnormal NST or modified BPP. Antepartum fetal surveillance: ACOG practice bulletin, number 229. 18. Br J Obstet Gynaecol. 2018;51(6):731-737. Ultrasound Obstet Gynecol. Detection rates for combinations of multiple markers varied between 38 % and 100 %. Two reviewers independently selected studies that evaluated the accuracy of ophthalmic artery Doppler to predict the development of PE and extracted data to construct 22 tables. American College of Radiology (ACR), Expert Panel on Women's Imaging. See alsoCPB 0106 - Fetal Echocardiography and Magnetocardiography and CPB 0127 - Home Uterine Activity Monitoring. To perform NST, the mother is asked to denote when the fetus moves. 1998;77(5):527-531. Centers for Medicare and Medicaid Services (CMS) in the 1997 Documentation Guidelines. Abnormal fetal cerebral and umbilical Doppler measurements in fetuses with intrauterine growth restriction predicts the severity of perinatal morbidity. Ultrasounds Standardize reports and interpretations Practice guidelines through the AIUMPractice guidelines through the AIUM (American Institute of . Resnik R. Fetal growth restriction: Evaluation and management. Stamford, CT: Appleton & Lange; 1999:201-227. Key concept: The most important factor is that the patient marks the fetal movements. 1994;84(3):424-426. Summary ROC curves showed that, among suspected SGA fetuses, the best predictive accuracy of abnormal third-trimester UAD was for perinatal mortality and the worst was for composite adverse perinatal outcome, with areas under the summary ROC curves of 0.90 and 0.66, respectively. Clin Lab. Question: Our ob-gyn practice is now certified to do nuchal translucency risk assessment. Ultrasound evaluation of the placenta in healthy and placental syndrome pregnancies: A systematic review. Detection rate (DR) was 72 % for a false-positive rate (FPR) of 15 %, an area under the curve (AUC) of 0.81 (95 % CI: 0.69 to 0.93). 2000;342(1):52-53. 1998;32(1):39-47. A total of 106 women who presented with post-menopausal bleeding were enrolled in this study. Abnormal UAD was defined as uterine artery PI of greater than 95th percentile or greater than or equal to 2 SD above the mean, or bilateral uterine artery notching. ACOG Technical Bulletin No. It relies on the premise that fetal oxygenation will be transiently worsened by uterine contractions. Only the delivery component of the maternity care is provided, and the postpartum care is performed by another physician or group of physicians. These researchers carried out a systematic search to identify relevant observational studies and RCTs evaluating the performance of abnormal third-trimester UAD for the prediction of adverse perinatal outcome in suspected SGA fetuses and SGA neonates. 25. In a systematic review and meta-analysis, Kalafat and colleagues (2018) determined the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of PE. They stated that future studies should be designed to address small changes in peri-natal outcome, and should focus on potentially preventable deaths. The angiogenic factors of interest include vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), as well as two anti-angiogenic proteins, soluble endoglin (sEng) and the truncated form of the full-length VEGF receptor type-1 (Flt-1), known as soluble fms-like tyrosine kinase 1 (sFlt-1) However, blood and urine levels of these factors have not been proven to be clinically useful for prediction of preeclampsia remote from disease onset Maternal serum analyte testing is an important component of Down syndrome screening programs. Hysteroscopic resection of polypoid endometrial lining [], Question: When the ob-gyn has a procedure such as a LEEP, we dont bill for []. First, these researchers were yet to validate their findings in an external cohort; thus, they could not be certain that their model would perform as well in other populations. Among 2,267 enrolled women, 191 (8.4 %) delivered an SGA infant. -We also don't code for a labor check when the patient goes to the hospital for observation and is then admitted for delivery.-On the other hand, you may find a way to be indirectly reimbursed for the labor check. 2021;57(1):75-83. The more accurate one of Doppler parameters was MCA, with sensitivity and specificity values of 85.7 % and 77.9 %, respectively, for the cut-off value delta MCA 25 %. Acta Obstet Gynecol Scand. Small-for-gestational-age at birth was significantly associated with a 5.4 % increase in serum YKL-40 at 32 weeks of gestation (95 % CI: 1.5 to 9.3, p = 0.005). var container = document.getElementById(slotId); Provider Search Results in. The clinical findings of other studies that the association of UAD with adverse outcome was independent of brain Doppler made a strong correlation between these parameters unlikely. 1997;9(5):330-338. The authors concluded that endoglin, sFlt-1 and PlGF are potential early screening parameters for the development of PE in pregnant women with autoimmune diseases like APS and SLE. Middle cerebral artery peak systolic velocity in the prediction of fetal anemia. Prediction and differential diagnosis. The LHD can bill 59430, S0281 and codes for the contraceptive device and insertion.