Basics of CPT code 76827 & 76828

Fetal echocardiography is a diagnostic fetal ultrasound test that checks the baby’s heart while the baby is still in the uterus. It can diagnose heart defects and check for heart rhythm problems. Fetal echocardiography is performed using a two-dimensional (2-D) high resolution ultrasound system. Generally the standard 2-D echocardiogram is performed if a structural abnormality is found. Doppler flow mapping may be used to identify the area affected with an altered blood flow. The doppler then measures the speed of the flow, direction of the flow, pressure differences and cardiac output. M-mode echocardiography may also be used. Today, we will learn about the procedure CPT code 76827 & 76828.

When to use CPT code 76827 & 76828

Diagnostic ultrasound is an imaging technique bouncing sound waves far above the level of human perception through interior body structures. The sound waves pass through different densities of tissue and reflect back to a receiving unit at varying speeds. The unit converts the waves to electrical pulses that are immediately displayed in picture form on screen. These codes report fetal doppler echocardiography by pulsed or continuous sound wave.
Report 76827 for a complete fetal echocardiographic evaluation and 76828 for a follow-up or repeat study.

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

76828 follow-up or repeat study

Coding Guidelines for CPT code 76827 & 76828

CPT 76827 are performed only once per fetus, if 76827 is billed is more than one time per fetus,
claim(s) will be denied and provider will need to resubmit claim(s) with the correct CPT code (76828).

Follow-up Doppler fetal echocardiograms are reported as CPT 76828. CPT code 76828 will be reimbursed when reported with modifier 59 for follow-up or repeat studies for the second and any additional fetuses.

If the patient is having an OB ultrasound and an E/M visit on the same date of service, by the Same Individual Physician or Other Health Care Professional, per ACOG coding guidelines the E/M service may be reported in addition to the OB ultrasound if the visit is identified as distinct and separate from the ultrasound procedure. Per CPT guidelines, modifier 25 should be appended to the E/M service to identify the service as separate and distinct.