Certainly! CPT codes 76818 and 76819 are used to report the performance of a biophysical profile, which is a prenatal ultrasound examination used to assess the well-being and health of a fetus. Here’s a knowledge guide for these CPT codes:
CPT Code: 76818 Description: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (>14 weeks 0 days), transabdominal approach; single or first gestation
Guidelines for coding:
- Use CPT code 76818 to report a biophysical profile performed via a transabdominal approach on a pregnant patient after the first trimester (>14 weeks 0 days) for a single or first gestation.
- A biophysical profile is a noninvasive assessment of fetal well-being that typically includes five components: fetal heart rate (FHR) monitoring, fetal breathing movements, fetal movements, fetal tone, and amniotic fluid volume.
- The biophysical profile is often used to evaluate the health and development of the fetus, assess fetal distress or potential complications, and guide decision-making regarding the timing and mode of delivery.
- CPT code 76818 includes both the fetal and maternal evaluations, as well as image documentation.
CPT Code: 76819 Description: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (>14 weeks 0 days), transabdominal approach; each additional gestation (list separately in addition to code for primary procedure)
Guidelines for coding:
- Use CPT code 76819 to report each additional gestation (i.e., multiple gestations) when performing a biophysical profile via a transabdominal approach on a pregnant patient after the first trimester (>14 weeks 0 days).
- CPT code 76819 should be reported in addition to the primary procedure code (e.g., 76818) when evaluating multiple fetuses in a single pregnancy.
- Each additional gestation should be listed separately in addition to the code for the primary procedure.
- Note that CPT code 76819 is an add-on code and should not be reported alone, but only in conjunction with the primary procedure code.
It’s important to note that CPT codes and guidelines are subject to change, and it’s always best to consult the most current version of the CPT codebook and any relevant payer guidelines for accurate coding and billing. It’s also recommended to involve qualified coding professionals, such as certified medical coders, for proper coding and reimbursement practices. Additionally, make sure to follow all applicable laws, regulations, and coding guidelines when submitting claims for reimbursement. The above information is provided for general informational purposes only and should not be considered as legal, coding, or billing advice. Always consult with qualified professionals for specific coding and billing guidance. Proper coding is the responsibility of the provider of services. Lastly, it’s important to ensure that you are coding within the scope of your practice and according to the applicable laws and regulations in your jurisdiction. Always consult with qualified professionals, such as certified medical coders, for proper coding and billing practices.