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. Nabhan AF, Abdelmoula YA. Utility of antepartum umbilical artery Doppler velocimetry in intrauterine growth restriction. Indiana Medicaid: Providers: Code Sets 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. Mean risk for controls was 2 % 4.1. These factors may have contributed to the relatively small number of patients enrolled in this study. Penning S, Garite TJ. Angiogenic marker prognostic models in pregnant women with hypertension. Moreover, the pattern of its expression in certain tissues (e.g., human liver or cartilage) suggested that YKL-40 may also serve as an inflammatory marker involved in inflammatory states and vascular processes (Johansen et al, 2006). Billing for non-global re may occur if: A patient transfers into or out of a physician or group practice. J Ultrasound Med. Still snag [], Bust 3 Myths to Increase Pay Without Raising a Red Flag, Youre most likely to use modifier 22 in these situations. 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. } However if the services are reported to evaluate and manage a problem, these codes would be reported. 2016;220(4):166-172. PDF Reimbursement Rate For Cpt Code 59000 Pdf ; Copy Obstet Gynecol. Serum YKL-40 was associated with increasing maternal age (p < 0.0001), body mass index (BMI; p = 0.0002), primiparity (p = 0.0003), and hypertension (p = 0.015). Am J Obstet Gynecol. Aetna considers PIGF Preeclampsia Screen (a biochemical assay of placental growth factor) experimental and investigationalbecauseits effectiveness has not been established. We're committed to supporting you in providing quality care and services to the members in our network. Billing and Remittance Code Sets The Indiana Health Coverage Programs (IHCP) provides a number of code tables for provider reference, including: Codes necessary for billing and claim processing Codes billable for certain types of services and by certain provider types or specialties ("code sets") These investigatorssearched the Cochrane Pregnancy and Childbirth Group Trials Register (May 2010). Simple removal of cerclage (not under anesthesia). The empirical results on DR at 10 % FPR were consistent with the modelled results. Waltham, MA: UpToDate; reviewed October 2018. Br J Obstet Gynaecol. Uterine artery Doppler was assessed and outcome was registered from medical records. Barkehall-Thomas A, Wilson C, Baker L, et al. 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. There was a negative correlation between sFlt-1 and maternal BMI (rS = -0.225, p = 0.005). Bahado-Singh RO, Oz AU, Hsu C, et al. All trials had adequate allocation concealment, but none had adequate blinding of participants, staff or outcome assessors. background: #5e9732; American College of Obstetricians and Gynecologists (ACOG). 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. The review concluded that, "[u]ntil such time as these are available, routine uterine artery Doppler screening of women considered at low risk is not recommended.". They performed a prospective screening study of singletons at 11 to 14 weeks. 3. Don't Overlook ICD-9 Ultrasound Obstet Gynecol. In addition to standard meta-analysis, the 2 primary outcomes and 5 of the secondary outcomes were assessed using GRADE software and methodology. Uterine artery Doppler velocimetry for the detection of adverse obstetric outcomes in patients with elevated mid-trimester beta-human chorionic gonadotrophin. Did you report combo code 58152 rather than 51840? Park et al (2014) attempted to establish a cut-off value for the sFlt-1/PlGF ratio measured using the Elecsys assay to predict late-onset PE in low-risk pregnancies. Copyright Aetna Inc. All rights reserved. The PubMed/Medline, Embase, PsycINFO, Maternity and Infant Care, Trip, Cochrane Library, and CINAHL databases were searched using the search terms pregnancy; stress; fetus; blood; Doppler; ultrasound. Uterine artery Doppler and biochemical markers (PAPP-A, PIGF, sFlt-1, P-selectin, NGAL) at 11 + 0 to 13 + 6 weeks in the prediction of late (> 34 weeks) pre-eclampsia. 1998;32(1):39-47. The guides detail billing guidelines, duplicate billing, corrected claims processes and many more topics. 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. 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. Overall the best discordancy predictor was delta EFW with sensitivity and specificity values of 100 % and 95.7 %, respectively, for the cut-off value delta EFW 17.9 %. text-decoration: underline; The Society for Maternal-Fetal Medicine Publications Committees report on "Doppler assessment of the fetus with intrauterine growth restriction" (Berkley et al, 2012) provided evidence-based guidelines for utilization of Doppler studies for fetuses with IUGR. Alfirevic Z, Stampalija T, Gyte GM. 12. 2010;93(7):759-764. BILLING Guideline for CPT Code 59425, 59409, S5100 and T1023 A total of 145 women were left for analysis after exclusions; 14 developed PE, 23 pregnancy-induced hypertension (PIH), 64 SGA of less than fifth centile, 118 SGA of less than 10th centile and 3 stillbirth. Only 1 included trial assessed serious neonatal morbidity and found no evidence of group differences (RR 0.99, 95 % CI: 0.06 to 15.75; 1 study, 2,016 participants). It is expressed and secreted by several types of solid tumors; however, the exact function of YKL-40 in cancer is unclear. Click here to see the total pay, recent salaries shared and more! 1998;77(5):527-531. 29. Among the 63 sets of twins studied, 33 pars fulfilled the study criteria; 21 pars were bi-chorionic, 7 mono-chorionic and 5 with unknown chorionicity; 10 sets of twins were discordant (303 %). First diastolic peak velocity of ophthalmic artery Doppler at a cut-off of 23.3cm/s showed modest sensitivity (61.0 %; 95 % CI: 44.2 to 76.1%) and specificity (73.2 %; 95 % CI: 66.9 to 78.7 %) for the prediction of early-onset PE (AUC, 0.68; 95 % CI: 0.61 to 0.76). 2014;44(4):411-418. Although the slope of the sFlt-1/PlGF ratio was not used in their algorithms, this value may be useful for enhancing predictive accuracy in a future larger scale study. 2006;16(2):120-123. Fetal Diagn Ther. Banta DH, Thacker SB. N Engl J Med. ACOG Practice Bulletin No. Centers for Medicare and Medicaid Services (CMS) in the 1997 Documentation Guidelines. 2007;72(3):175-180. Giles WB, Trudinger BJ, Baird PJ. Practical guidelines for antepartum fetal surveillance. 26. They stated that the findings of this review justify efforts to elucidate the effectiveness and underlying mechanism whereby 2 seemingly unrelated maternal vessels can be used for the prediction of a disease considered a "placental disorder". Ultrasound Obstet Gynecol. 2018;60(6):553-559. var container = document.getElementById(slotId); Other Manuals. 2nd ed. The best cut-off for predicting PE was a PMDV of greater than22.11cm/s, with sensitivity of 70 %, specificity of 75 %, positive likelihood ratio of 2.8, negative likelihood ratio of 0.4, positive predictive value (PPV) of 28 % and negative predictive value (NPV) of 95 %. .newText { PDF Updated: New! Mid-level Reimbursement Matias DS, Costa RF, Matias BS, et al. Policy Manage Settings This test is rarely used in clinical practice at this time. Moreover, this review does not mention AFP. Doppler assessment of the fetoplacental circulation in normal and growth-retarded fetuses. For most pregnancies at increased risk of stillbirth due to utero-placental insufficiency, testing is considered appropriate beginning at 32 to 34 weeks of gestation. ins.style.width = '100%'; list-style-type: upper-roman; Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); May 2002. These investigators searched MEDLINE, EMBASE and Cochrane databases from inception until March 2015 without language restrictions. Additionally, the Cochrane Library, organizational guidelines, and studies identified through review of the above were utilized to identify relevant articles. Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery. Antepartum fetal surveillance using NST, CST, BPP, or modified BPP is considered medically necessary for women with risk factors for stillbirth due to utero-placental insufficiency. Management of surgical problems arising during pregnancy (e.g. Ultrasound Obstet Gynecol. 2002;99(4):589-593. ins.className = 'adsbygoogle ezasloaded'; When you-re reporting 59025, you-d better be sure you-ve got supporting documentation--and the supporting diagnosis to justify this code. 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. The CPT book describes the 59025 CPT code as: "Fetal non-stress test.". Non-global OB care. When you-re reporting 59025, you-d better be sure you-ve got supporting documentation--and the supporting diagnosis to justify this code. 10. The physiologic and medical rationale for intrapartum fetal monitoring. 2019 53(4):465-472. Moreover, these researchers stated that further studies are needed to evaluate the usefulness of the combined screening test in low-risk populations. The ob-gyn interprets the strip and writes (or dictates) a report that he must include in the patient's record. /* aetna.com standards styles for templates */ 59000 59070 Antepartum and Fetal Invasive Services for. Find out, Learn These In-House Lab Codes And Lasso Reimbursement, Tests with different names don't always mean different codes, See How Your Hysterectomy Responses Measure Up. Ultrasound Obstet Gynecol. } These investigators reviewed published systematic reviews to collate evidence on the ability of available tests to predict PE, to identify high-value avenues for future research and to minimize future research waste in this field. Baltimore, MD: Williams & Wilkins; 1996:433-442. van Asselt K, Gudmundsson S, Lindqvist P, et al. Eur J Obstet Gynecol Reprod Biol. CPT code information is copyright by the AMA. 2003;189(5):1320-1324. From basic check-ups to advanced screenings, obstetrical procedures strive to ensure the safety and health of both the mother and the baby. padding-bottom: 4px; Aetna considers the use of maternal serum ischemia-modified albumin as a biomarker for preeclampsia experimental and investigationalbecausethe effectivenessof this approach has not been established. Cochrane Database Syst Rev. Furthermore, frequency of antepartum testing and certain aspects of obstetric intervention are reduced with use of Doppler." Fetal and umbilical Doppler ultrasound in normal pregnancy. Therefore when the facility is billing for observation services, an outpatient claim will be submitted under a 13X or 85X Type of Bill (TOB). American College of Obstetricians and Gynecologists. Coding Question: Non-Stress Test during Labor Management Seravalli V, Block-Abraham DM, Turan OM, et al. 6. Modifier 25 fact sheet - Novitas Solutions 2005;89(3):251-257. 2002;19(3):293-296. These researchers recorded the average of the 4 measurements, 2 from the right and 2 from the left eye, for the following 4 indices: first PSV, second PSV, PI, and ratio of second to first PSV. Description This policy is to provide direction on global maternity care which includes pregnancy-related antepartum care, admission to Labor and Delivery, management of labor including fetal monitoring, delivery, and uncomplicated postpartum care until six weeks postpartum. } The most commonly interrogated vessels are the umbilical arteries. Middle cerebral artery Doppler velocimetric deceleration angle as a predictor of fetal anemia in Rh-alloimmunized fetuses without hydrops. The following CPT codes are for delivery services only: Vaginal delivery only (with or without episiotomy and/or, Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps), Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery, Based on CPT and ACOG guidelines, the following items are included in the delivery service codes and should not be reported separately, The admission history and physical examination, Management of uncomplicated labor, vaginal delivery (with or without, episiotomy, with or without forceps), or cesarean delivery, external and internal, fetal monitoring provided by the attending physician, Intravenous induction of labor via oxytocin (CPT code 96365-96367), Repair of first or second degree lacerations*, Insertion of cervical dilator (CPT 59200) to be included if performed on the same, If the physician or group physician provide the delivery and postpartum care only, there are CPT codes that encompass both of these services. Question: Our ob-gyn practice is now certified to do nuchal translucency risk assessment. 1992;166(2):489-492. 1991;98:956-963. Ultrasound Obstet Gynecol. Recording of weight, blood pressures and fetal heart tones. 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 %). UpToDate [online serial]. Therefore, you can report the initial care separately from the global ob period. Modifier TC Fact Sheet - Novitas Solutions Medicare NCCI Medically Unlikely Edits | CMS Serum IMA, complete blood count (CBC), liver function tests (LFT), renal function tests (RFT), albumin, and C-reactive protein (CRP) were measured in the mothers immediately before birth, and in the cord blood and serum of the newborns at 6 and 24 hours after birth. The postpartum period for CPT code 59430 (postpartum care only) will change from 45 days to a 90 day period. Should older women have antepartum testing to prevent unexplained stillbirth? CAPC Billing Series) with Andy Esch, MD, MBA and Phillip Rodgers, MD, FAAHPM Wed, August 28 at 12:30pm ET Virtual Office Hours: - Billing for Community Palliative Care with Anne Monroe, MHA Wed, June 19 at 2:00pm ET - Billing and RVUs in Hospital-Based Palliative Care with Julie Pipke, CPC Fri, June 21 at 12:30pm ET Resources: Perry et al (2020) examined the prognostic value of angiogenic markers and maternal risk factors in pregnant women with hypertension. A total of 347 women were recruited, of whom 40 developed PE. Br J Obstet Gynaecol. Maternal characteristics, highest UtA pulsatility index and serum placental biomarkers including PAPP-A, PIGF, soluble fms-like tyrosine kinase 1 (sFlt-1), P-selectin and neutrophil gelatinase-associated lipocalin were recorded. The authors stated that this study had several drawbacks. Outcomes of interest included PE, early PE (defined as requiring delivery at less than 34 weeks' gestation), and gestational hypertension. Lancet. 24. Maternal characteristics along with blood samples for angiogenic marker analysis were obtained from participants. Noninvasive testing for fetal anemia. . Youssef et al (2011) examined the performance of screening for late PE by maternal characteristics, uterine artery (UtA) Doppler and a set of biochemical markers in prospectively enrolled women at 11 + 0 to 13 + 6 weeks. Studies where uterine vessels have been assessed together with fetal and umbilical vessels have been included. The following CPT codes is used to report postpartum care only: Postpartum care only (separate procedure), https://www.acog.org/practice-management/coding/coding-library. The authors concluded that this combination of maternal biochemical variables in the 1st trimester could detect a consistent number of late PE. The review noted, however, thatfurther study is needed to determine which high-risk conditions are amenable to such screening, what testing regimen is optimal for a normal or abnormal test in these women, and what interventions based on these findings will improve pregnancy outcomes. PDF Billing and Coding for Advance Care Planning (ACP) Conversations - CAPC MD Lindheimer, JM Roberts, FG Cunningham, eds. The acoustic stimulation may be repeated up to 3 times, each time for progressively longer durations (up to 3 seconds), to elicit fetal heart rate accelerations. Efficiency of first-trimester uterine artery Doppler, a-disintegrin and metalloprotease 12, pregnancy-associated plasma protein a, and maternal characteristics in the prediction of preeclampsia. At uni-variate analysis women with SGA neonates were younger, more frequently African-American (AA), nulliparous, more likely to smoke, have lower PAPP-A and free -hCG levels. OL OL OL LI { If the member is seen four or more times prior to delivery for prenatal care and the provider performs the delivery, and performs the postpartum care then the provider must bill the Global OB code. Although other trials would be desirable before asserting a definite lack of benefit (due to the problem of statistical heterogeneity and lack of power), umbilical Doppler examination cannot be recommended as a routine test in low- risk pregnancies.". Reston, VA: ACR; 2001. The false positive rate has been shown to increase following 33 weeks gestation. 2005;84(8):743-747. This trial included women attending for a routine hospital visit at 35+0 to 36+6 weeks' gestation. A total of 17 observational studies (including 7,552 fetuses either diagnosed with suspected SGA (n = 3,461) or later diagnosed as a SGA neonate (n = 4,091)) met the inclusion criteria; no RCTs met the inclusion criteria. Predictive sensitivity was low; receiver operating characteristic curve analysis yields areas under the curve of 0.592 (95 % confidence interval [CI]: 0.548 to 0.635) for the combination of Ut-A Doppler and UA PI z-scores. Most payers do not cover the NST unless your ob-gyn documented a specific reason,- Engstrom says. ol.numberedList LI { For additional quantities, please contact [emailprotected] var slotId = 'div-gpt-ad-codingahead_com-box-3-0'; The NST is based on the premise that the heart rate of a fetus that is not acidotic or neurologically depressed will temporarily accelerate with fetal movement. A larger number of patients may have resulted in different accuracy rates for the combinations evaluated in this study; however, there was a steep increase in the sFlt-1/PlGF ratio in patients with PE, which was consistent with previously reported results, and these investigators expected that the main conclusions would not change with a larger study population. OL OL OL OL OL LI { Curr Opinion Obstet Gynecol. Irion O, Masse J, Forest JC, Moutquin JM. 2008;32(4):243-246. .strikeThrough { However, the reliability of amniotic fluid bilirubin measurements has been questioned and these tests are of limited value in the second trimester. When expanded it provides a list of search options that will switch the search inputs to match the current selection. 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. Karsdorp VH, van Vugt JM, van Geijn HP, et al. American College of Obstetricians and Gynecologists (ACOG), Committee on Practice Bulletins -- Obstetrics. Absent or reversed end-diastolic flow in the umbilical artery is associated with an increased risk of perinatal mortality. J Reprod Immunol. Normal Doppler studies could potentially lead to a reduction in such testing and interventions. Pregnancy related E/M office visits must not be billed in conjunction with code, 59425 or 59426 by the same provider for the same beneficiary, during the same. Per the ACOG Coding Committee, the following is a brief description of CPT code 59025,Fetal NST: Pediatr Int. However, if a reassuring test is achieved within the first 10 minutes or less, the patient does not have to be monitored for the additional time. However, in the United Kingdom, the National Institute for Health and Care Excellence suggests offering PlGF-based testing to help rule out (but not rule in) preeclampsia in women presenting with suspected preeclampsia up to 35 weeks of gestation [citing NICE, 2019]. Am J Obstet Gynecol. ProviderOne You file all claims through the ProviderOne portal. The important factor here is that the ob-gyn did not admit the patient for delivery. J Coll Physicians Surg Pak. Prediction of preeclampsia with maternal mid-trimester placental growth factor, activin A, fibronectin and uterine artery Doppler velocimetry. Broadly speaking, the global OB package covers routine maternity services, dividing the pregnancy into three stages: antepartum (also known as prenatal) care, delivery services, and postpartum care. The authors concluded that this study may be the first to demonstrate maternal and fetal macrophage activation in pre-eclampsia. 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. When the quality of the evidence for the main comparison of "All Doppler versus no Doppler" was assessed with GRADE software, the outcomes of perinatal death and serious neonatal morbidity data were graded as of low quality. short description, long description, guidelines and more. First, due to the study design, these findings were applicable only to late SGA (greater than or equal to32weeks). Most likely you-ll include this fetal monitor use as part of labor management or the global ob package (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care).Example: A patient at 38 weeks gestation presents to the ob-gyn saying her water has broken but she doesn't feel any contractions. Low JA. This was a prospective cohort study that included pregnant women in the second trimester who had risk factors for PE. Waltham, MA: UpToDate;reviewed September 2014; November 2015. Acta Obstet Gynecol Scand. Martinez-Portilla RJ, Caradeux J, Meler E, et al. "Tests for measurement of angiogenic factors are commercially available in some countries (not the United States) but are generally still considered investigational. Antepartum Fetal Surveillance - Medical Clinical Policy Bulletins - Aetna Thus, once IUGR is suspected or diagnosed, Doppler velocimetry may be useful as a part of fetal evaluation. Am J Obstet Gynecol. OL OL LI { Gudmundsson S, Marsal K. Umbilical and uteroplacental blood flow velocity waveforms in pregnancies with fetal growth retardation. Tip: Make sure you include labor checks in the global ob codeDo you want to code fetal non-stress test (NST) using 59025? 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. 175: Ultrasound in pregnancy. 1994;344:1664-1668. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. 1999;26(3):549-568. For additional language assistance: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation, each additional gestation (List separately in addition to code for primary procedure), Fetal biophysical profile; with non-stress testing, Obstetrics (preeclampsia), biochemical assay of placental-growth factor, time-resolved fluorescence immunoassay, maternal serum, predictive algorithm reported as a risk score for preeclampsia, Asthma [steroid dependent or poorly controlled], Systemic lupus erythematosus, organ or system involvement unspecified, Proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium, Pre-existing diabetes mellitus in pregnancy, childbirth and the puerperium, Gestational diabetes in pregnancy, childbirth and the puerperium, Abnormal findings on antenatal screening of mother, Maternal care for known or suspected placental insufficiency, Maternal care for other known or suspected poor fetal growth, Pregnancy with inconclusive fetal viability, Maternal care for abnormalities of the fetal heart rate or rhythm, Placenta previa, premature separation of placenta [abruptio placentae], antepartum hemorrhage, not elsewhere classified, Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy [Antiphospholipid syndrome], Other endocrine, nutritional and metabolic diseases complicating pregnancy, childbirth and the puerperium, Diseases of the circulatory system complicating pregnancy, Diseases of the respiratory system complicating pregnancy, childbirth and the puerperium [asthma], Abnormal glucose complicating pregnancy, childbirth and the puerperium, Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium [systemic lupus erythematosus (SLE)], Encounter for supervision of normal pregnancy, Doppler velocimetry, fetal; umbilical artery [not covered for studies of ductus venosus and vessels for surveillance of impaired fetal growth], Maternal care for fetal anemia and thrombocytopenia, Fetus-to-fetus placental transfusion syndrome, Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study, Complications of pregnancy, childbirth, and the puerperium, Normal pregnancy, postpartum care and examination, encounter for contraceptive management, procreative management, outcome of delivery, and encounter for antenatal screening of mother, Doppler velocimetry, fetal; middle cerebral artery, Maternal care for (suspected) damage to fetus from viral disease in mother, Fetomaternal placental transfusion syndrome, Other viral diseases complicating pregnancy, childbirth and the puerperium [parvovirus B-19 infection], Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified [not covered for serum YKL-40], Pre-existing hypertension with pre-eclampsia, Maternal care for other known or suspected poor fetal growth [small-for-gestational age fetuses], Transcranial Doppler study of the intracranial arteries; complete study [not covered for the prediction of pre-eclampsia], Transcranial Doppler study of the intracranial arteries; limited study [not covered for the prediction of pre-eclampsia].