CodeRyte has observed that a commonly miscoded procedure is the fetal biophysical profile (BPP). The BPP code is reported when an ultrasound observation is performed to assess the physiologic status of the fetus. This is not just a series of anatomical measurements.

This profile might or might not have an accompany non-stress test done with it. If the fetal biophysical profile is done with a non-stress test, it is a 76818; if it’s done without a non-stress test, it’s a 76819. The examination consists of specific observations made by real-time ultrasound:

• Fetal breathing
• Fetal movement
• Fetal tone
• Amniotic fluid volume
• Optional fetal non-stress test

The physician interpretation, the determination of the BPP score and final report are also components of the code. You can find more information on how the BPP is scored here.

During the procedure, the mother lies on her left side to maximize blood flow to the baby. The healthcare provider usually does a non-stress test first. This involves pasting electrodes on the skin of the mother's abdomen.The baby's heart tracing is then recorded through the skin painlessly. This is followed by a detailed pregnancy ultrasound. The BPP results in a score of zero to 10. Each part of the profile may receive a score of zero or two.The higher the score, the better. The scoring is as follows:

• Fetal breathing movements: The baby gets a score of two if he or she has normal breathing activity. A score of zero is given for an absence of normal breathing activity.
• Fetal body movements: A score of two is given for normal, active body movements. A score of zero means absent or decreased movements.
• Fetal tone: The baby gets a score of two if his or her arms and legs are flexed with one episode of stretching or extending the limbs. A score of zero means the baby didn't move or doesn't have normal flexed arm and leg positions.
• Amniotic fluid volume: A baby receives a score of two if there is a normal amount of amniotic fluid. Too little amniotic fluid results in a score of zero.
• Fetal non-stress test: The baby gets a score of two if the heart rate is normal over time. If the heart rate is not normal, the baby gets a score of zero.

Another good source of BPP scoring information can be found here.

If a BPP is performed with a non-stress test, the total points possible would be 10. If a BPP is performed without a non-stress test, the total points possible would only be eight. Sometimes physicians document BPP scores as fractions (e.g.  7/8 or 9/10). In order to get at a BPP score, the physician would have to measure these four or five parameters and determine a score for each parameter in order to calculate the total BPP score. At a minimum, documentation of a fetal biophysical profile should consist of the final score, which is only determined once these parameters been measured. Simple documentation of a BPP score of eight out of eight or nine out of 10 would probably be acceptable.

To confuse matters, physicians sometimes list a number of anatomical or biometric measurements that are being made on a fetus (BPD, HC, OFD, AC, HL, FL) and occasionally will collectively refer to these measurements as a fetal biophysical profile. But don’t be fooled: while these are important clinical measurements to be sure, unless a report has a fetal biophysical profile score (of, for example “eight out of eight” or “nine out of 10,”), then a Fetal BPP (76818 or 76819) as defined by CPT wasn’t actually done.

Additional information from the Society for Maternal Fetal Medicine Coding Manual answers additional coding questions about the fetal biophysical profile can be found here.

Gregory Schnitzer, R.N., CCS, CCS-P, CPC, CPC-H, RCC, CHC, CodeRyte Coding Quality Expert