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The CPT® Code 76821 refers to the procedure known as Doppler velocimetry, specifically focusing on the fetal middle cerebral artery. This advanced ultrasound technique is utilized to assess blood flow velocity within the middle cerebral artery of a fetus. The primary purpose of this procedure is to evaluate fetal well-being, particularly in situations where there may be concerns regarding fetal anemia or the optimal timing for labor induction. During the procedure, the expectant mother is typically positioned in a semi-recumbent posture with a slight lateral tilt, which is essential for minimizing the risk of supine hypotension syndrome—a condition that can occur when a pregnant woman lies flat on her back, potentially leading to decreased blood flow to the fetus. To facilitate the ultrasound examination, an acoustic coupling gel is applied to the skin of the lower abdomen, ensuring proper transmission of the ultrasound waves. A transducer is then placed against the abdomen, and the operator manipulates it to capture Doppler frequency shift waveforms from the middle cerebral artery. This process involves the use of either continuous wave or pulsed wave Doppler interrogation techniques to assess the blood flow dynamics by evaluating downstream impedance. The resulting Doppler waveforms are displayed on a video monitor, allowing for real-time visualization of the blood flow patterns. When appropriate signals are identified, the screen is frozen to allow for precise measurements. These measurements are critical as they are used to calculate various indices that characterize the downstream impedance of the blood flow, including the pulsatility index (PI), which is the most commonly utilized index for the middle cerebral artery. Following the completion of the procedure, the physician meticulously reviews the ultrasound imaging, calculates the relevant indices, evaluates the blood flow velocity within the middle cerebral artery, and subsequently provides a comprehensive written report detailing the findings. This structured approach ensures that the assessment of fetal health is thorough and accurate, aiding in clinical decision-making regarding the management of the pregnancy.
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The procedure of Doppler velocimetry of the fetal middle cerebral artery is indicated for several specific clinical scenarios. These include:
The procedure for performing Doppler velocimetry of the fetal middle cerebral artery involves several key steps, which are detailed as follows:
After the completion of the Doppler velocimetry procedure, the physician will typically provide the patient with information regarding the findings and any necessary follow-up actions. The results of the Doppler assessment may influence clinical decisions regarding the management of the pregnancy, including the timing of labor induction or further monitoring of fetal health. Patients may be advised on any additional tests or evaluations that may be required based on the results obtained. It is essential for the healthcare provider to communicate clearly with the patient about the implications of the findings and to ensure that appropriate care is continued throughout the pregnancy.
| Short Descr | MIDDLE CEREBRAL ARTERY ECHO | Medium Descr | DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART | Long Descr | Doppler velocimetry, fetal; middle cerebral artery | 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 | STV-Packaged Codes | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I4B - Imaging/procedure - other | 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. | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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. | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 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 | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician |
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| 2005-01-01 | Added | First appearance in code book in 2005. |
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