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2025 CPT code 76826

Follow-up or repeat real-time fetal echocardiography, with or without M-mode recording, for evaluating the fetal cardiovascular system.

Adhere to CPT coding guidelines for ultrasound procedures, including image documentation and report requirements.Appropriate modifiers (e.g., 59 for a distinct procedure performed on the same day) should be added based on payer requirements and clinical circumstances.

Modifiers 26 (professional component), TC (technical component), 59 (distinct procedural service), 76 (repeat procedure), and others may be applicable based on the circumstances and payer requirements.Refer to payer guidelines for specific modifier rules.

Medical necessity for a repeat fetal echocardiogram is established by a prior finding of a potential cardiovascular anomaly, family history of congenital heart defects, or maternal conditions that could impact fetal cardiac development.The physician's clinical judgment is paramount in ordering this procedure.

The clinical responsibility involves a physician (cardiologist, maternal-fetal medicine specialist, obstetrician, or radiologist) interpreting the ultrasound images and providing a report.A sonographer (ultrasound technician) may perform the technical aspects of the exam.

IMPORTANT 76825 (initial complete fetal echocardiography), Modifiers 26 (professional component), TC (technical component), 59 (distinct procedural service)

In simple words: This test uses ultrasound to take another look at your baby's heart.It's like a repeat ultrasound of the baby's heart to check if everything is okay.

This CPT code encompasses a follow-up or repeat real-time fetal echocardiography examination. The procedure involves using ultrasound technology to create two-dimensional images of the fetal heart, with or without the inclusion of M-mode recording (which captures movement of structures like heart valves).The goal is to evaluate the fetal cardiovascular system, typically following a prior echocardiography study. The examination includes assessment of heart structures, function, and rhythm.

Example 1: A patient had a prior fetal echocardiogram at 20 weeks gestation showing a possible abnormality. A repeat echocardiogram is performed at 28 weeks to assess the heart’s development and rule out significant issues., A patient with a family history of congenital heart disease undergoes a routine fetal echocardiogram at 22 weeks.Follow-up echocardiogram is performed at 32 weeks to monitor the heart's development., A patient with suspected cardiac abnormality detected during a routine obstetric ultrasound undergoes a detailed fetal echocardiogram to assess the condition. A repeat exam is ordered later in the pregnancy to reassess the condition.

* Detailed report of the findings of the echocardiogram, including measurements and images.* Documentation of the reason for the repeat study (e.g., prior abnormal findings, family history).* Gestational age at the time of the study.* Any relevant clinical information about the mother or fetus.

** Always refer to the most current CPT codebook and payer guidelines for definitive coding and reimbursement information. This information is for guidance only and should not be considered definitive medical advice.

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