Wiki Modified fetal biophysical profile

[klcampbe]

We have providers performing a modified BPP, where an ultrasound for amniotic fluid volume index is combined with an NST. I am hearing conflicting information about how to code for this service. Some recommend reporting 76815 with 59025, and others recommend reporting the BPP (76819). Any recommendations?

 

[imjsanderson]

76818 is a BPP with NST, have you looked at this code?

 

[klcampbe]

Yes, I've looked at that code. The problem, is they aren't doing 3 of the other 4 parts of the test. A BPP requires 1) fetal trunk and extremity movement; 2) fetal tone; 3) fetal breathing movement; 4) amniotic fluid volume;. They only do the AFI with the NST, so I'm not sure that I can report the BPP with NST.

Thanks for your help.

 

[cjbrock]

If they only do an AFI then I would code a brief u/s 76815 along with the nst 59025.

 

[ajfreeba]

Given the paranthetical note following code 76819 "(for AFI without non-stress test, use 76815)," and Meciare's CCI edit which precludes the reporting of 76815 and 59025 together unless performed during separate encounters, I would not recommend following the above recommendation to report these codes for the service.

I do note the CPT Assistant articles which seem to clearly show that 76818 may not be repoorted without the performance of what they call the five key components; however, given the lack of direction on which code to use, I would consider 76818 with a -52 modifier.