Basics about CPT ode 76825 & 76826

Obstetric Ultrasound is a highly developed technique used to detect ectopic pregnancy and multiple pregnancies, assessing fetal life and function, diagnosing physical anomalies, and guiding physicians in their efforts to treat the fetus. Although the clinical benefit of routine ultrasonography has not been established, it is commonly performed early in pregnancy for confirmation of dates, fetal viability, and pregnancy location. Later studies at 16-20 weeks are used to assess fetal anatomy and to identify potential fetal abnormalities. In addition, there are a variety of complications that require ultrasound for evaluation. Today, we will checkout about CPT code 76825 & 76826 for Echocardiography of fetal cardiovascular system

When to use CPT code 76825 & 76826

The physician performs fetal echocardiography with real-time image documentation (2D) with or without M-mode recording to assess the structure and function of the fetal heart. This test is performed during pregnancy to evaluate the unborn baby for suspected cardiovascular anomalies, particularly when there is a family history of congenital heart disease, the obstetrician has detected an abnormal fetal heart rhythm, anomalies of the heart or other major organ systems have been seen on a routine ultrasound, the mother has Type I diabetes or has taken drugs during pregnancy that are known to affect fetal heart development, or an amniocentesis is abnormal.

Fetal echocardiography may be performed using abdominal or transvaginal ultrasound. If an abdominal ultrasound is performed, gel is applied to the abdomen and the transducer probe is moved over the abdomen to obtain images from different locations. If a transvaginal ultrasound is used, a transducer is inserted into the vagina to obtain images of the heart.

Two-dimensional (2D) echocardiography provides images of heart structure and motion. The 2D echo appears as a cone-shaped image on a video monitor and the heart structures and motion are observed in real time, meaning that heart motion is observed as it is happening. This allows the physician to evaluate the heart structures as the heart is beating. Selective time-motion (M-mode) recordings are made as needed to allow dimensional measurement.

M-mode displays more specific time-motion information from a stationary beam that is superimposed over the 2D image. Depth is oriented along the vertical axis and time on the horizontal axis. M-mode is used to evaluate heart wall and septa thickness and timing of the opening and closing of aortic, mitral, and tricuspid valves. M-mode may also be used to evaluate the pericardium and aorta. CPT code 76825 is reported for the initial study or CPT code 76826 for a follow-up or repeat study.

If all of the elements of the initial fetal echocardiogram are documented, it is appropriate to report code 76825. Elements of the initial fetal echocardiogram include: imaging of the fetus to identify fetal orientation and the fetal cephalic/caudal ends, extremities, and spine; determination of fetal sinus (fetal visceral orientation); evaluation of all parts of the heart, including venous connections, chambers, competence and movement of valves, and great arterial connections; and evaluation of cardiac function with M mode (and/or spectral Doppler when indicated).

76825 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording;
76826  follow-up or repeat study

Report 76827 for a complete fetal echocardiographic evaluation and 76828 for a follow-up or repeat study

Indication for Fetal echocardiography CPT code 76825 & 76826:

• Abnormal obstetrical ultrasound screen
• Extracardiac abnormality
• Chromosomal abnormality
• Arrhythmia
• Hydrops
• Increased first trimester nuchal transluncency
• Multiple gestation and suspicion of twin-twin transfusion syndrome

Related Ultrasound CPT codes for Fetal evaluation

76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation

76812 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)

76813 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation

76814 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure)

76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heartbeat, placental location, fetal position, and/or qualitative amniotic fluid volume), one or more fetuses

76816 Ultrasound, pregnant uterus, real time with image documentation, follow up (e.g., re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be
abnormal on a previous scan), trans abdominal approach per fetus.

76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal; for n-obstetrical transvaginal ultrasound use 76830; If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 in
addition to appropriate transabdominal exam code.

76818 Fetal biophysical profile; with non-stress testing

76819 Fetal biophysical profile; without non-stress testing

76820 Doppler velocimetry, fetal; umbilical artery

76821 Doppler velocimetry, fetal; middle cerebral artery

76827 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete

76828 Doppler echocardiography, fetal pulsed wave and/or continuous wave with spectral display; follow up or repeat study

HCPCS codes linked to CPT code 76825 & 76826

G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema

G0130 Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
G0248 Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient’s ability to perform testing and report results
G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels
G2066 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
Q0035 Cardiokymography