76819-26 and 59025-26,59 - we see this sometimes.
Coding for NST and BPP
Date postedJanuary 18, 2024
in
Coding Tips
Authors: The Society for Maternal-Fetal Medicine (SMFM) Coding Committee; Steve Rad, MD, FACOG; Trisha Malisch, CCS-P, CPC.
Coding Tip:
MFM subspecialists often see patients for antepartum testing. Here we provide guidance on coding for these services.
- CPT code 76818 is billed when fetal biophysical profile is performed with non-stress testing.
- CPT code 76819 is billed when fetal biophysical profile is performed without non-stress testing.
- CPT code 59025 is billed when fetal non-stress testing is performed alone.
- CPT codes 76815 + 59025 are billed when modified biophysical profile (AFI + non-stress testing) is performed.
These codes are indication driven. The appropriate code should be billed based on the clinical indication and test(s) performed.
In what circumstance is it appropriate to unbundle CPT 76818 and instead bill/code 76819 + 59025 on the same date of service by the same provider/group (same Taxonomy Subspecialty and Tax ID)?
Unbundling should seldom be performed by the same provider on the same date of service. If NST and BPP services are provided on the same date of service, but different places of services (POS), e.g. clinic and hospital, it would be appropriate to bill separately on the same date for these separate encounters.
Another possible but more uncommon scenario would be, if the NST and BPP are both done in the same place of service by the same provider for different indications at different times on the same date, e.g. patient returns to your office/hospital same day later time for a BPP after having an NST done earlier in the day. The documentation must clearly support the need to complete the procedures on the same day. Please note that if the procedures are billed separately (unbundled), the appropriate modifier 59 or XE should be applied (as well as modifier 26 if indicated). As a reminder, it is important to understand your individual payer guidelines when billing for these services. Some payers may not support unbundling in any scenario.
https://www.smfm.org/news/coding-for-nst-and-bpp