Ob-Gyn Coding Alert

Question: If I am performing a complete ultrasound (76805) or a detailed fetal anatomy (76811), does this include a fetal biophysical profile (BPP)?

Pennsylvania Subscriber Answer: The BPP (76818, Fetal biophysical profile; with non-stress testing; and 76819, without non-stress testing) is separate from the 76805 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester [> or = 14 weeks 0 days], transabdominal approach; single or first gestation) or 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation). A BPP measures fetal well-being while the ultrasounds measure anatomic structures. Therefore, you can bill for both.

In fact, CPT details exactly what the ultrasound codes include. Code 76805 represents determination of number of fetuses and amniotic/chorionic sacs, measurements appropriate for gestational age (> or = 14 weeks 0 days), survey of intracranial/spinal/abdominal anatomy, 4 chambered heart, umbilical cord insertion site, placenta location and amniotic fluid assessment and, when visible, examination of maternal adnexa. On the other hand, according to CPT, 76811 includes everything in 76805, plus detailed anatomic evaluation of the fetal brain/ventricles, face, heart/outflow tracts and chest anatomy, abdominal organ specific anatomy, number/length/architecture of limbs and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated.