Basics or biophysical profile CPT code 76818 & 76819

Fetal biophysical profile score (BPS or BPP) refers to assessment of four discrete biophysical variables by ultrasound. It is often a standard tool in antepartum fetal assessment. It is usually  assessed after 28 weeks of gestation. The BPP combines data from two machines, ultrasonographic imaging and fetal heart rate [FHR] monitoring. Biophysical profile CPT code 76818 & 76819 are used in medical coding.

A biophysical profile consists of five elements — four of which are studied with ultrasound, and the fifth element, which involves a nonstress test usually administered by the patient’s obstetrician. The four elements that are scored from an ultrasound study.

The ultrasound variables include

Fetal trunk and extremity movement
Fetal tone
Fetal Breathing movement (gross body movement)
Amniotic fluid volume

 Each of these parameters is given a score of either 0 or 2 points where an abnormal score gets 0 while a normal score gets 2.

Therefore, on ultrasound assessment, a total score is given out of 8. An overall abnormal score out of 8 is often taken as 4/8 or less.

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Description of Biophysical profile CPT Code 76818 & 76819

We have two CPT Codes used for coding Biophysical Profile. The procedure is done with non-stress and without non-stress. Following are the two CPT codes are used for Biophysical profile.

76818- Fetal biophysical profile; with non-stress testing

76819- Fetal Biophysical Profile; without Non-stress testing

76820 – Doppler velocimetry, fetal; umbilical artery

The CPT codes can be used again depending on the number of fetus.

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.

This code may be assigned as a stand-alone service, or may be assigned in addition to any other OB ultrasound study performed at the same encounter. Code 76819 is reported per fetus. A biophysical profile performed along with a nonstress test is coded 76818. A nonstress test performed without a biophysical profile is coded 59025. 

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Criteria for Coding biophysical profile CPT code 76818 & 76819

If biophysical profile assessments are done on multiple fetuses, report 76818 or76819 separately as appropriate for each fetus after the first and append modifier 59 or an X{EPSU} modifier to additional codes. For example, if we have twins A and B and physician performs Biophysical profile procedure on both. Then any one of the cpt will have 59 or X {EPSU} modifier to bill both the procedure. So, the final code will be

A-76819 and B-76819-59 or X {EPSU}

A-76818 and B-76818-59 or X {EPSU}

Sample Report for Biophysical Profile

US FETAL BIOPHYSICAL PROFILE WO NON STRESS

CPT 76819    

INDICATION: oligohydramnios

US FETAL BIOPHYSICAL PROFILE WO NON STRESS

HISTORY: Oligohydramnios – BPP

TECHNIQUE/SCAN QUALITY

FETAL EVALUATION Num Of Fetuses: 1 Preg.

Location: Intrauterine Fetal Pole:

Visualized Fetal Heart Rate: 139 bpm

Cardiac Activity: Visualized.

Presentation:Cephalic

 Placenta: Anterior. No previa.

Amniotic Fluid AFI FV:

Oligohydramnios AFI Sum: 6.77 cm

4 % Tile

Larg Pckt: 3.55 cm

RUQ: 2.26 cm

LUQ: 0.0 cm

RLQ: 3.55 cm

LLQ: 0.96 cm

BIOPHYSICAL EVALUATION Amniotic F.

V: Pocket => 2 cm two F.

Tone: Observed

planes F.

Movement: Observed

Score: 8/8 F.

Breathing: Observed

BIOMETRY

GESTATIONAL AGE Clinical EDD: 38 w 2 d

EDD: 02/09/15

Best: 38 w 2 d

Det.

By: Clinical EDD

EDD: 02/09/15

IMPRESSION: Normal biophysical profile with score of 8/8. Oligohydramnios. AFI measures 6.77 cm, previously 9.9 cm.