Radiology Coding Alert

Question: I have a report for a patient who is pregnant with twins. The radiologist performed a fetal biophysical profile for the fetuses without nonstress testing. Should I append modifier 76 to the second CPT^® code?

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Answer: No, you won’t append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to the CPT^® code because the radiologist didn’t perform a repeat procedure on the same fetus. Instead, you’ll assign 76818 (Fetal biophysical profile; with non-stress testing) on the first claim line for the first fetal biophysical profile, and then you’ll assign 76818 appended with modifier 59 (Distinct procedural service) on the second claim line to report the same procedure performed on the second fetus.

Each fetus represents a complete biophysical profile and needs a full physician evaluation. By appending modifier 59 to the second instance of 76818, you’ll distinguish the biophysical profile performed for the second fetus.