Transcription of DID YOU ICD Diagnosis Codes are Mandatory. PATIENT …
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Aneuploidy Screening92777 QNatalTM Advanced for Fetal Chromosomal Abnormalities (as early as weeks gestation) DO NOT report (opt out) for microdeletions (subchromosomal copy variant) DO NOT report (opt out) for fetal sexCollection Date: _____/_____/_____ Two x 10mL Cell Free DNA Streck TubesEstimated Date of Delivery (EDD): _____/_____/_____ (mandatory)Number of Fetuses: One Two Three More than 3 Maternal Height:_____ in. Maternal Weight: _____ lbs)MEDICAL INDICATION FOR TESTING Select one or more ICD10 Codes if appropriate -or add additional code to describe clinical indicationHigh risk for fetal chromosomal aneuploidiesAdvanced Maternal Age: Primigravida 1st tri 2nd tri 3rd tri Multigravida 1st tri 2nd tri 3rd triAbnormal (MSS) serum biochemical screening: Other: Abnormal Ultrasound finding: (specify ty
Aneuploidy Screening 92777 SPECIMEN KEY ON BACK QNatal TM Advanced for Fetal Chromosomal Abnormalities (as early as 10.0 weeks gestation) Quest, Quest Diagnostics ...
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