OB Ultrasound code 76819 for an Amniotic Fluid Index only?

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Hi Everyone,

I am a CPC-A extern working at an ultrasound center that performs ultrasounds mainly on pregnant patients.

Here is the discussion that has come up recently (and kind of ongoing) :

Can code 76819, Fetal biophysical profile, without non-stress testing, be used if only an Amniotic Fluid Index was done, and not the biophysical profile, as well as a follow-up ultrasound, code 76816? I pointed out to the technologist that in the CPC book, it says under code 76819 that "for amniotic fluid index without non-stress test, use 76815". But he says that you can't code 76815, a limited, with a more complete code of 76816. So he uses 76819 instead to represent amniotic fluid index only, along with 76816.

Does that statement under code 76819 mean that when one only does an amniotic fluid index and nothing else, you can use 76815?

Any input on this would be greatly appreciated!

Thank you!

Maureen Baetz, CPC-A
Batavia, IL
 

staceyg11

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76819 is for a BPP without NST. ALL the elements needed for BPP are required to be documented to bill this code (breathing, gross and fine fetal movement, fluid)

"The four elements that are scored from an ultrasound study are amniotic fluid, breathing, gross body movements, and fine motor movements. A score of "2" or "0"is given for each element, and the radiology report will give the score received out of the possible 8 points, in the format "8/8". Reporting of this score satisfies the required documentation of the study being performed. The fetus must be observed under ultrasound for a specified period of time to determine if the body movements are present. Correct coding for the biophysical profile score of the four elements (without nonstress testing) is 76819."

If AFI is the only thing being documented then 76815 (limited study) is the more appropriate code. 76816 includes AFI level.

"Code 76815 also would be used for an intended quick look or selected limited examination of any individual element of any OB study, such as amniotic fluid assessment."
" If a study is done to reassess fetal size, or to re-evaluate any fetal organ-system abnormality noted on a previous ultrasound study, 76816 is appropriate."

https://www.acr.org has further descriptions.

Stacey, COBGC
 
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Thank you Stacey.

I agree. But my boss kept on insisting to use 76819. So, can he still use 76816 with 76815, or should he just use 76816 when there is a follow-up ultrasound and an AFI?
 

staceyg11

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Well hopefully your boss will be able to explain the payment recoupements done when there is an audit. :(

If the only thing being documented is AFI then it is a 76815. A 76816 measures the fetus against standard parameters for growth or abnormal organ system.

76815 Limited Ultrasound
Key Elements
Examination is limited for a focused “quick-look/quickpeek”
assessment of one or more of these key
elements
 Fetal Position
 Fetal Heartbeat
 Placental location
 Qualitative amniotic fluid volume
Note: If an AFI only is noted/performed in the record
– this is the CPT code/scan that should be billed

76816 Follow-Up Ultrasound
Key Elements
Examination is limited to the following elements
 Focused Assessment of fetal size by measuring BPD
(Bi-Parietal Diameter), abdominal circumference,
femur length or other appropriate measurement
OR
 Detailed re-examination of a specific organ or
system known or suspected to be abnormal
 Comparison of this examination to a prior study to
evaluate the interval change (i.e. fetal growth)
 
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