ultrasound type

[Korbc]

hey guys!
so is this a 76819 vs 76815. One of my providers says she lists the bpp as part of the limited ultrasound to be thorough but if they look at those 4 components or so that makes up a bpp then can i charge for a bbp without nst? I'm a bit confused about what a bpp being part of a limited ultrasound but also it's own separate code 76819
thanks

TAUS done for DFM: SIUP w/ +FCA 141, +FM, +breathing, +flexion/extension, +tone, AFI 10.05cm, posterior placenta, cephalic.

Reviewed with pt that BPP is 8/8. Pt is very reassured. Precautions given.

 

[nielynco]

hey guys!
so is this a 76819 vs 76815. One of my providers says she lists the bpp as part of the limited ultrasound to be thorough but if they look at those 4 components or so that makes up a bpp then can i charge for a bbp without nst? I'm a bit confused about what a bpp being part of a limited ultrasound but also it's own separate code 76819
thanks

TAUS done for DFM: SIUP w/ +FCA 141, +FM, +breathing, +flexion/extension, +tone, AFI 10.05cm, posterior placenta, cephalic.

Reviewed with pt that BPP is 8/8. Pt is very reassured. Precautions given.

She did both 76819 and 76815 as the notation of posterior placenta and cephalic position would meet the requirements for 76815. The rest of the documentation supports 76819. These 2 codes are not bundled.

 

[Korbc]

She did both 76819 and 76815 as the notation of posterior placenta and cephalic position would meet the requirements for 76815. The rest of the documentation supports 76819. These 2 codes are not bundled.

thanks! i will def have to learn more regarding this area

 

[Korbc]

She did both 76819 and 76815 as the notation of posterior placenta and cephalic position would meet the requirements for 76815. The rest of the documentation supports 76819. These 2 codes are not bundled.

and also if you have any good resources of a nice break down of the requirements or chart i would love to have it and be so appreciative!

 

[Korbc]

She did both 76819 and 76815 as the notation of posterior placenta and cephalic position would meet the requirements for 76815. The rest of the documentation supports 76819. These 2 codes are not bundled.

Hey Melanie,
I'm really trying to and having trouble discerning when a bpp and limited ultrasound are done together with all my providers
is this just a bpp or because they mention cephalic position that it's bpp and limited us. or is it just that she happen to notice cephalic position during bpp and that doesn't count alone as separate limited.

"BPP performed. Cephalic presentation, EFW 3217g (41%), AFI 12.9cm ,FHR 139 bpm. Movement/flex/ext/tone seen. "

 

[Korbc]

She did both 76819 and 76815 as the notation of posterior placenta and cephalic position would meet the requirements for 76815. The rest of the documentation supports 76819. These 2 codes are not bundled.

and then would this be a 76815 and 76819 because the flexion and extension is supportive for the 76819?

OB Ultrasound findings: Vertex, MVP 5.3 cm, anterior placenta without notable defects, + multiple fetal movements including flexion and extension, breathing noted

thank you so much!

 

[Korbc]

She did both 76819 and 76815 as the notation of posterior placenta and cephalic position would meet the requirements for 76815. The rest of the documentation supports 76819. These 2 codes are not bundled.

this one looks like she's just saying bpp as part of the 76815 which also throws me, would this be a 76815 and a 76819?

TAUS: transverse with fetal head at left side of abdomen, anterior placenta, AFI=19.38 cm BPP 8/8

 

[Korbc]

She did both 76819 and 76815 as the notation of posterior placenta and cephalic position would meet the requirements for 76815. The rest of the documentation supports 76819. These 2 codes are not bundled.

for the above response and this one i have a particular hard time with the way this particular doctors notes discerning the two differences
she notes in the beginning of the note
Bedside ultrasound shows BPP 8/8. AFI 19.33 cm. Breech presentation
then at the end
TAUS: breech, lateral placenta, AFI= 19.33, BPP 8/8, including NST 10/10

would this be 76815 and 76818 or just 76818?

 

[nielynco]

for the above response and this one i have a particular hard time with the way this particular doctors notes discerning the two differences
she notes in the beginning of the note
Bedside ultrasound shows BPP 8/8. AFI 19.33 cm. Breech presentation
then at the end
TAUS: breech, lateral placenta, AFI= 19.33, BPP 8/8, including NST 10/10

would this be 76815 and 76818 or just 76818?

Per the vignette submitted when 76818 was added to CPT, the work is as follows:

Intra service info: Place the patient in recumbent position or in a cardiac chair and locate fetal heart sounds with continuous-wave Doppler transducer that is then secured in place with belts or straps. Also secure a tocodynamometer to the uterine fundus to record uterine contradictions and generate a paper tracing of the heart rate and uterine activity for up to 30 minutes. After the non-stress test, use an abdominal transducer to perform the following four observations to complete the biophysical profile: fetal breathing movements (one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes); fetal movements (three or more discrete body or limb movements within 30 minutes); fetal tone (one or more episodes of fetal extremity extension with return to flexion); and quantification of amniotic fluid volume (a pocket of amniotic fluid that measures at least 1 cm in two planes perpendicular to each other).

The vignette for 76815 states the following: intra service info: The sonographer performing the examination is supervised. Interpretation of the examination is limited to focused quick look assessment of one or more of the key elements: fetal position, fetal heart beat, placental location, and qualitative amniotic fluid volume. A report for the medical record is prepared.

As you can see there is overlap with the heart beat and AFI. So while you could technically bill 76815 if the provider also looked at fetal position and/or placental location, the question I would ask would be: was it medically indicated? If, for instance, the physical exam already confirms breech at the time of the visit, why confirm on ultrasound? The documentation is not clear and this is something I would discuss with your providers. Also be sure there is an actual strip for this finding. A bedside ultrasound does not always produce a strip and if not, the service is not billable - this is in the CPT guidelines.

 

[Korbc]

Per the vignette submitted when 76818 was added to CPT, the work is as follows:

Intra service info: Place the patient in recumbent position or in a cardiac chair and locate fetal heart sounds with continuous-wave Doppler transducer that is then secured in place with belts or straps. Also secure a tocodynamometer to the uterine fundus to record uterine contradictions and generate a paper tracing of the heart rate and uterine activity for up to 30 minutes. After the non-stress test, use an abdominal transducer to perform the following four observations to complete the biophysical profile: fetal breathing movements (one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes); fetal movements (three or more discrete body or limb movements within 30 minutes); fetal tone (one or more episodes of fetal extremity extension with return to flexion); and quantification of amniotic fluid volume (a pocket of amniotic fluid that measures at least 1 cm in two planes perpendicular to each other).

The vignette for 76815 states the following: intra service info: The sonographer performing the examination is supervised. Interpretation of the examination is limited to focused quick look assessment of one or more of the key elements: fetal position, fetal heart beat, placental location, and qualitative amniotic fluid volume. A report for the medical record is prepared.

As you can see there is overlap with the heart beat and AFI. So while you could technically bill 76815 if the provider also looked at fetal position and/or placental location, the question I would ask would be: was it medically indicated? If, for instance, the physical exam already confirms breech at the time of the visit, why confirm on ultrasound? The documentation is not clear and this is something I would discuss with your providers. Also be sure there is an actual strip for this finding. A bedside ultrasound does not always produce a strip and if not, the service is not billable - this is in the CPT guidelines.

thanks so much! most of them say more detail and the indication, i only copied a pasted the actual ultrasound verbiage to try to understand when i can charge a 76815. Good to know about the strip! i didn't know that part. One of my physicians has brought up the point of them not thinking you would bill a 76815 with a 76819 because any of the components you would see in a 76815 you would see in a 76819 anyway.......and lets just say a physical exam wasn't performed and they just do the ultrasound. given this information would be your take on not billing the 76815 with a 76819 because you would see what you would see in a 76815 in a 76819 anyway?

thank you so much!

 

[nielynco]

thanks so much! most of them say more detail and the indication, i only copied a pasted the actual ultrasound verbiage to try to understand when i can charge a 76815. Good to know about the strip! i didn't know that part. One of my physicians has brought up the point of them not thinking you would bill a 76815 with a 76819 because any of the components you would see in a 76815 you would see in a 76819 anyway.......and lets just say a physical exam wasn't performed and they just do the ultrasound. given this information would be your take on not billing the 76815 with a 76819 because you would see what you would see in a 76815 in a 76819 anyway?

thank you so much!

Again, what was the reason it was necessary to know either placental location or fetal position at the time of the NST? There must be a medically indicated reason for doing so.

 

[Korbc]

Again, what was the reason it was necessary to know either placental location or fetal position at the time of the NST? There must be a medically indicated reason for doing so.

they gave the med necessity for it before the paragraph that i copied and pasted i just didn't past that part because that part was already checked off and not what i was wondering about i just specifically was wondering documentation between a limited transab ultrasound and bpp and if what you see on a transab ultrasound is already a part of a bpp then if you can really charge separate for it, but med necessity was already accounted for and not a component i was inquiring about, sorry if that threw you! thanks so much melanie!