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A fetal biophysical profile (BPP) is a comprehensive assessment performed during pregnancy to evaluate the well-being of the fetus. This procedure utilizes ultrasound imaging to measure several critical parameters, including the volume of amniotic fluid, fetal breathing movements, gross body movements, and fetal muscle tone. The BPP is particularly significant as it aids in predicting the presence or absence of fetal asphyxia, which is a condition that can lead to inadequate oxygen supply to the fetus, and it also assesses the risk of fetal death during the antenatal period. The procedure is typically conducted when the mother presents with a full bladder, which enhances the clarity of the ultrasound images. During the examination, an acoustic coupling gel is applied to the skin of the lower abdomen to facilitate the transmission of ultrasound waves. A transducer is then placed against the skin and moved back and forth to locate the fetus and assess cardiac activity. Additionally, the position of the placenta may be noted during this general examination. Following this initial assessment, the ultrasound is used to evaluate the amniotic fluid volume, observe gross fetal movements and tone, and assess fetal breathing movements. A non-stress test (NST) may also be performed concurrently, which involves monitoring the fetal heart rate for a minimum of 30 minutes to gather further insights into fetal well-being. The results of the BPP are quantified into a biophysical score (BPS), which helps in determining the risk of fetal asphyxia and fetal death. The physician is responsible for reviewing the ultrasound images, interpreting the NST results, calculating the BPS, and providing a written report of the findings. The specific CPT® code 76818 is designated for instances where the BPP is performed in conjunction with the NST, while code 76819 is applicable when the BPP is conducted without the NST.
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The fetal biophysical profile (BPP) with non-stress testing (NST) is indicated for various clinical scenarios where fetal well-being needs to be assessed. The following conditions may warrant the performance of this procedure:
The procedure for conducting a fetal biophysical profile (BPP) with non-stress testing (NST) involves several detailed steps to ensure accurate assessment of fetal well-being. The following steps outline the process:
After the completion of the fetal biophysical profile (BPP) with non-stress testing (NST), the mother may be advised to continue monitoring fetal movements and report any significant changes to her healthcare provider. The results of the BPP and NST will guide further management and monitoring of the pregnancy. Depending on the findings, additional follow-up appointments or interventions may be necessary to ensure the ongoing health and safety of both the mother and the fetus. The physician will discuss the results with the mother, including any implications for her pregnancy and any recommended next steps based on the biophysical score and overall assessment.
| Short Descr | FETAL BIOPHYS PROFILE W/NST | Medium Descr | FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING | Long Descr | Fetal biophysical profile; with non-stress testing | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I3B - Echography/ultrasonography - abdomen/pelvis | MUE | 2 | CCS Clinical Classification | 197 - Other diagnostic ultrasound |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | KX | Requirements specified in the medical policy have been met | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2001-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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