CPT code 76828 is for an ultrasound exam focused on assessing the fetal heart, providing detailed images to evaluate cardiac structure and function.
CPT code 76828 is used for an echocardiography examination of the fetal heart. This procedure involves using ultrasound technology to create detailed images of the heart of a fetus. It is typically performed to assess the structure and function of the fetal heart, identify any congenital heart defects, and monitor the heart's development during pregnancy. This code is specifically used when a comprehensive evaluation of the fetal heart is required, often in cases where there is a known risk or suspicion of heart abnormalities.
When considering the use of modifiers for CPT codes 76827 and 76828, it is important to ensure accurate billing and reimbursement for fetal echocardiography services. Here is a list of potential modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the echocardiogram, not the technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and technical staff, not the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the echocardiography is performed as a distinct service from other procedures on the same day. It helps to indicate that the services are not bundled and should be reimbursed separately.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the same physician performs a repeat echocardiography on the same day. It indicates that the procedure was necessary and not a duplicate billing error.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a repeat echocardiography is performed on the same day by a different physician. It helps to clarify that the repeat procedure was necessary and not a duplicate billing error.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room): If the echocardiography is performed again due to complications or unforeseen circumstances, this modifier indicates that the procedure was necessary and related to the initial procedure.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician): This modifier is used when the echocardiography is unrelated to the original procedure performed by the same physician during the postoperative period.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although less common for echocardiography, this modifier could be used if the test needs to be repeated for clinical reasons on the same day.
Each modifier should be used based on the specific circumstances of the service provided, ensuring compliance with payer policies and accurate representation of the services rendered.
CPT code 76828 is indeed reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services covered under Medicare Part B, and CPT code 76828 is listed among those services.
However, it's important to note that reimbursement can vary based on geographic location and other factors. Medicare Administrative Contractors (MACs) are responsible for processing claims and determining the specific reimbursement rates for each region.
Therefore, healthcare providers should consult their local MAC to obtain precise information regarding the reimbursement amount for CPT code 76828 in their area.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 76828, RevFind provides unparalleled insights by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and maximize your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
