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The CPT® Code 76825 refers to a specialized imaging procedure known as fetal echocardiography, which focuses on the cardiovascular system of a fetus. This procedure utilizes real-time imaging technology, specifically two-dimensional (2D) echocardiography, to capture detailed images of the fetal heart. The examination may also incorporate M-mode recording, which provides additional insights into the heart's motion and structure. Fetal echocardiography is primarily performed during pregnancy to assess the fetal heart for potential cardiovascular anomalies. This assessment is particularly critical in cases where there is a known family history of congenital heart disease, abnormal fetal heart rhythms detected by the obstetrician, or when other major organ system anomalies are observed during routine ultrasounds. Additionally, maternal health factors such as Type I diabetes or the use of certain medications during pregnancy that may impact fetal heart development warrant this examination. The procedure can be conducted using either abdominal or transvaginal ultrasound techniques, depending on the clinical scenario. The 2D echocardiography provides a dynamic view of the heart's structure and function, allowing healthcare providers to observe the heart in real time as it beats. This capability is essential for evaluating the heart's anatomy and function accurately. M-mode recordings, when utilized, enhance the assessment by offering precise measurements of heart wall thickness, septal integrity, and the timing of valve movements, which are crucial for diagnosing potential cardiac issues in the fetus.
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The fetal echocardiography procedure, coded as CPT® 76825, is indicated for several specific clinical scenarios that warrant detailed evaluation of the fetal heart. These indications include:
The procedure for fetal echocardiography (CPT® 76825) involves several key steps to ensure accurate imaging and assessment of the fetal heart. These steps include:
After the fetal echocardiography procedure is completed, the physician will review the obtained images and recordings to assess the fetal heart's structure and function. The results will be discussed with the patient, and any necessary follow-up actions or referrals to specialists will be determined based on the findings. Patients may be advised on any further monitoring or additional tests that may be required. It is important for the healthcare provider to document the findings thoroughly, as this information is crucial for ongoing prenatal care and management of any identified issues.
| Short Descr | ECHO EXAM OF FETAL HEART | Medium Descr | ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING | Long Descr | Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording; | 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 MPFS nonfacility PE RVUs. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I3B - Echography/ultrasonography - abdomen/pelvis | MUE | 2 | CCS Clinical Classification | 193 - Diagnostic ultrasound of heart (echocardiogram) |
This is a primary code that can be used with these additional add-on codes.
| 93325 | Addon Code MPFS Status: Active Code APC N PUB 100 CPT Assistant Article Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) |
| 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. | 63 | Procedure performed on infants less than 4 kg: procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician or other qualified health care professional work commonly associated with these patients. this circumstance may be reported by adding modifier 63 to the procedure number. note: unless otherwise designated, this modifier may only be appended to procedures/services listed in the 20100-69990 code series and 92920, 92928, 92953, 92960, 92986, 92987, 92990, 92997, 92998, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93452, 93505, 93563, 93564, 93568, 93569, 93573, 93574, 93575, 93580, 93581, 93582, 93590, 93591, 93592, 93593, 93594, 93595, 93596, 93597, 93598, 93615, 93616 from the medicine/ cardiovascular section. modifier 63 should not be appended to any cpt codes listed in the evaluation and management services, anesthesia, radiology, pathology and laboratory, or medicine sections (other than those identified above from the medicine/cardiovascular section). | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | 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 | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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