AHA Coding Clinic® for HCPCS - 2010 Issue 3; ASK the EDITOR

Fetal Biophysical Profile

At our facility, pregnant patients are sometimes referred for a fetal biophysical profile, which is performed in the radiology department and interpreted by a radiologist, and a non-stress test, which is performed by nursing and interpreted by the ordering physician. Our current coding practice is to report these two procedures with CPT code 76818, Fetal biophysical profile; with non-stress testing. When reporting this way, we have several charge correction issues. Additionally, a radiologist at our facility disagrees with this practice. The radiologist believes that CPT code 59025, Fetal non-stress test, should be reported for the non-stress test, and CPT code 76819, Fetal biophysical profile; without non-stress testing, should be reported for the fetal biophysical profile, with modifier 59, Distinct Procedural Service, appended to 76819. Additionally, the radiologist does not believe that it is appropriate to report the radiological portion of this service with 76818. From a hospital reporting perspective, what is the appropriate way to report a fetal biophysical profile performed in one area of the facility and a non-stress test performed in another area of the facility on the same date of service? ...

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