CPT 76819 is a code used for fetal biophysical profile without non-stress testing, assessing the health of a baby during pregnancy. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 76819 procedures.
1. What is CPT 76819?
CPT 76819 is a medical billing code used to describe a fetal biophysical profile without non-stress testing. This test is performed during pregnancy to assess the health and well-being of the baby using ultrasound technology. The biophysical profile measures fetal breathing, fetal movement, fetal tone, and amniotic fluid volume, providing valuable information about the baby’s development and overall health.
2. 76819 CPT code description
The official description of CPT code 76819 is: “Fetal biophysical profile; without non-stress testing.”
The 76819 procedure involves the following steps:
- The pregnant patient is positioned comfortably on an examination table.
- A gel is applied to the patient’s abdomen to facilitate the transmission of ultrasound waves.
- An ultrasound transducer is placed on the patient’s abdomen and moved slowly to capture images of the developing fetus and surrounding structures.
- The ultrasound examination measures fetal breathing, fetal movement, fetal tone, and amniotic fluid volume.
- Each of the four variables is given a score of zero for an abnormal indication or two for a normal result.
- The provider interprets the results and discusses them with the patient.
4. Qualifying circumstances
Patients eligible to receive CPT code 76819 services are pregnant women who require a fetal biophysical profile assessment without non-stress testing. This may be due to concerns about the baby’s health, abnormal prenatal screening results, or other risk factors that warrant closer monitoring of the baby’s development and well-being.
5. When to use CPT code 76819
It is appropriate to bill the 76819 CPT code when a provider performs a fetal biophysical profile without non-stress testing to assess the health and well-being of a baby during pregnancy. This code should be used when the provider is only using ultrasound technology and not performing a nonstress test as part of the assessment.
6. Documentation requirements
To support a claim for CPT 76819, the following information should be documented:
- Patient’s medical history and reason for the test
- Date and time of the ultrasound examination
- Details of the ultrasound examination, including the measurements of fetal breathing, fetal movement, fetal tone, and amniotic fluid volume
- Scoring of each variable and the total biophysical profile score
- Provider’s interpretation of the results and any recommendations for further testing or follow-up
7. Billing guidelines
When billing for CPT code 76819, keep in mind the following guidelines:
- Use modifier 59, Distinct Procedural Service, if the provider performs biophysical profile assessments for the second or any additional fetus.
- Use CPT 76815 for a limited real-time ultrasound of one or more fetuses if the provider measures only certain parameters.
- Use CPT 76818 if the provider measures the biophysical profile along with a nonstress test.
- Append professional component modifier 26 to the radiology code if reporting only the physician’s interpretation for the radiology service.
- Append modifier TC to the radiology code if reporting only the technical component for the radiology service. Note that payer policy may exempt hospitals from appending modifier TC because the hospital’s portion is inherently technical.
- Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.
8. Historical information
CPT 76819 was added to the Current Procedural Terminology system on January 1, 2001. The code was changed on January 1, 2002, from “Fetal biophysical profile; without stress or non-stress testing” to its current description.
9. Similar codes to CPT 76819
Five similar codes to CPT 76819 and how they differ are:
- CPT 76815: Limited real-time ultrasound of one or more fetuses, measuring only certain parameters.
- CPT 76816: Serial ultrasound evaluations of fetal size, measuring growth over time.
- CPT 76817: Transvaginal ultrasound examination of the pregnant uterus, providing a more detailed view of the fetus and surrounding structures.
- CPT 76818: Fetal biophysical profile with non-stress testing, combining ultrasound measurements with a nonstress test to assess fetal well-being.
- CPT 76820: Doppler umbilical artery waveform analysis, evaluating blood flow in the umbilical artery to assess fetal health.
Here are 10 detailed examples of CPT code 76819 procedures:
- A pregnant woman with a history of gestational diabetes undergoes a CPT 76819 procedure to assess her baby’s health and well-being.
- A patient with a high-risk pregnancy due to advanced maternal age has a CPT 76819 procedure to monitor her baby’s development.
- A pregnant woman with a previous pregnancy loss undergoes a CPT 76819 procedure to ensure her current baby’s health.
- A patient with abnormal prenatal screening results has a CPT 76819 procedure to further evaluate her baby’s health.
- A pregnant woman with a family history of genetic disorders undergoes a CPT 76819 procedure to assess her baby’s well-being.
- A patient with a history of preterm labor has a CPT 76819 procedure to monitor her baby’s development and well-being.
- A pregnant woman with a history of preeclampsia undergoes a CPT 76819 procedure to assess her baby’s health.
- A patient with a multiple pregnancy has a CPT 76819 procedure to evaluate the health and well-being of each fetus.
- A pregnant woman with a history of intrauterine growth restriction has a CPT 76819 procedure to monitor her baby’s growth and development.
- A patient with a history of placental abnormalities undergoes a CPT 76819 procedure to assess her baby’s health and well-being.