Coding

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Bpp and Limited

  • 1.  Bpp and Limited

    Posted 07-15-2020 09:16

    Good morning

    In my practice the question has been raised about billing a bpp and a limited with IUGR patients.  Are you able to bill both. I did not find a CCI edit but I wanted to confirm if the need is felt for a further review would a limited be appropriate or a follow up? 


    I thank you for your time. 

    Monica 



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    Monica Dowdell
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  • 2.  RE: Bpp and Limited

    Posted 07-15-2020 18:10
    Good day.

    You cannot generally bill a 76815 and 76818 together as the BPP includes most of the 76815. You could bill a 76816 if there was reason to do a follow-up in addition to a BPP, but not a limited.




    Best regards,


    David C Jones, MD
    Director, University of Vermont Medical Center Fetal Diagnostic Center
    Professor, Obstetrics, Gynecology & Reproductive Sciences
    University of Vermont
    Dept of Obstetrics, Gynecology & Reproductive Sciences
    Division of Maternal-Fetal Medicine
    (802) 847-5698









  • 3.  RE: Bpp and Limited

    Posted 07-16-2020 21:21
    76815 is usually billed alone.  If there is another indication for ultrasound 76816 is used.  76820 for umbilical artery Doppler.

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    Dimitry Zilberman
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  • 4.  RE: Bpp and Limited

    Posted 07-17-2020 11:11
    Thank you all for your input. The CPT descriptions and the respective elements of any study should be carefully considered in answering this question. While billing for a BPP + limited study may not be common, there are clinical situations where billing both is certainly appropriate. BPP is a test of fetal well-being, with specific elements included in its description. A limited ultrasound study is usually done for fluid check, viability, placenta evaluation, and/or presentation. Evaluation of the placenta or presentation are not included in a BPP evaluation. If you have an indication to do a BPP and a distinct indication to do a limited study (placenta or presentation), billing a BPP and a limited study would be appropriate in those situations. Similarly, a follow-up study 76816 can also be billed with a BPP if there is a distinct indication for each. On the other hand, billing for 76816 + 76815 would never be appropriate because all the elements of a limited study would be included in a follow-up study. Some payers may restrict you from billing 76815 or 76816 along with a BPP. This would be unique to that payer and should not be generalized to all situations.
    Hope this helps.
    Fadi

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    Fadi Bsat, MD
    Past Chair, SMFM Coding Committee
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  • 5.  RE: Bpp and Limited

    Posted 07-15-2020 19:02
    Hi,
    Dr. Jones is correct that BPP (76818, 76819) and limited (76815) generally cannot be billed together. In some limited circumstances, they may be billed together, if the indications exist for doing both, and the 76815 is being done to evaluate something that is not included in the BPP (fetal position, placental location). Modifier 59 would be necessary on 76815 if billing in these situations, and you would need to ensure that the appropriate ICD-10 code supporting each service is properly linked to the CPT code.
    Thank you,
    Trish

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    Trisha Malisch
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  • 6.  RE: Bpp and Limited

    Posted 07-15-2020 20:02
    I agree. To bill both you need to be using the limited to evaluate something the BPP doesn’t. Those would be placental position and, arguably, presentation



    Sent from my iPhone




  • 7.  RE: Bpp and Limited

    Posted 07-15-2020 20:34
    Hello Monica,
    Assuming the BPP has IUGR as the indication, you can also bill for a limited study if you have a distinct indication for it besides IUGR.
    For example, if IUGR is the sole indication, you would only bill a BPP. If the pregnancy is at term and the fetus is IUGR & breech, you would bill a BPP (IUGR) and a limited study (breech).
    Fadi

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    Fadi Bsat, MD
    Past Chair, SMFM Coding Committee
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