Coding

I recently joined a practice that routinely bills for a BPP at each growth scan after 28 weeks.  At the original consultation, for example for T2DM, the provider recommended serial growth scans and twice weekly fetal testing beginning at 32 weeks.  However when the patient arrived for her growth scan at 28-31 weeks she gets charged for the repeat 76816 but also a 76819 because the sonographer saw breathing, movement and tone (and took cine clips) during the exam.  Is this correct?  Can you bill for the BPP at the time of the growth scan if the growth is normal and nothing has clinically changed about the patient?

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Elizabeth G. Spooner, MD
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Hi Elizabeth,
Each submitted CPT must have a distinct indication to be billed. In the example you gave, you may be justified to bill a BPP along with growth for type 2 diabetes. However, having a "routine" in the practice to bill a BPP with every growth scan after 28 weeks without a distinct indication for the BPP would be problematic from an auditing standpoint.
Fadi.

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Fadi BSAT, MD, FAIUM
Chair, SMFM Practice Management Division
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Original Message:
Sent: 02-12-2022 04:14
From: Elizabeth Spooner
Subject: Billing for BPPs

I recently joined a practice that routinely bills for a BPP at each growth scan after 28 weeks.  At the original consultation, for example for T2DM, the provider recommended serial growth scans and twice weekly fetal testing beginning at 32 weeks.  However when the patient arrived for her growth scan at 28-31 weeks she gets charged for the repeat 76816 but also a 76819 because the sonographer saw breathing, movement and tone (and took cine clips) during the exam.  Is this correct?  Can you bill for the BPP at the time of the growth scan if the growth is normal and nothing has clinically changed about the patient?

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Elizabeth G. Spooner, MD
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This post was removed

This practice performs BPPs on all AMAs and on diet controlled gestational diabetes beginning at 34 weeks.  When I pointed out that this was not the recommendations of ACOG/SMFM I was told "They (ACOG &SMFM) set the minimum standard.  We are providing care that is above the minimum standard."

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Elizabeth Spooner
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Original Message:
Sent: 02-13-2022 12:42
From: Fadi BSAT
Subject: Billing for BPPs

Hi Elizabeth,
Each submitted CPT must have a distinct indication to be billed. In the example you gave, you may be justified to bill a BPP along with growth for type 2 diabetes. However, having a "routine" in the practice to bill a BPP with every growth scan after 28 weeks without a distinct indication for the BPP would be problematic from an auditing standpoint.
Fadi.

------------------------------
Fadi BSAT, MD, FAIUM
Chair, SMFM Practice Management Division

Original Message:
Sent: 02-12-2022 04:14
From: Elizabeth Spooner
Subject: Billing for BPPs

I recently joined a practice that routinely bills for a BPP at each growth scan after 28 weeks.  At the original consultation, for example for T2DM, the provider recommended serial growth scans and twice weekly fetal testing beginning at 32 weeks.  However when the patient arrived for her growth scan at 28-31 weeks she gets charged for the repeat 76816 but also a 76819 because the sonographer saw breathing, movement and tone (and took cine clips) during the exam.  Is this correct?  Can you bill for the BPP at the time of the growth scan if the growth is normal and nothing has clinically changed about the patient?

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Elizabeth G. Spooner, MD
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