Ob-Gyn Coding Alert

If coding amnio procedures -- particularly procedures involving polydramnios and twin-twin transfusion syndrome (TTTS) -- sets your heart aflutter, a few minutes brushing up on the basics will be just what you need to improve your amnio coding acumen.

Here's how: Take a look at the following amnio procedure and see if you-re on par with our expert-provided coding recommendations.

The ob-gyn sees a patient with a rapidly increasing uterine size at 22 weeks gestation.

Limited ultrasound scanning reveals the presence of a twin gestation. One twin is small for gestational age and has oligohyramnios. The other twin is appropriate for gestational age and has severe polyhydramnios.

The ob-gyn makes a diagnosis of a twin-twin transfusion syndrome and counsels the patient as to the available therapies. The patient elects amniotic fluid reduction. The ob-gyn explains the risks and benefits of the procedure.

He performs real-time ultrasound scanning to identify the sac with increased amniotic fluid. The physician drapes and preps the area. Then he identifies the needle insertion site. Under real-time ultrasound guidance, he inserts a 22-gauge needle into the amniotic sac.

He then attaches the needle to tubing by an assistant while the operator holds the needle in place. The assistant then attaches the needle to a drainage system. Using continuous ultrasonic guidance, he removes the fluid until he sees a normal amount of fluid on the ultrasound.

The physician remains in constant communication with the ultrasound operator regarding the status of both fetuses and the fluid level; this continual monitoring of the needle location is required to avoid injury to the fetus or placenta since the removal of fluid alters the uterine shape.

Once the patient has a normal fluid level, the physician removes the needle.

"The key term to look for is -polyhydramnios,- " says Arlene Smith, CPC, CCS-P, insurance and billing coordinator for Tacoma Women's Specialists in Washington. Why: "This indicates the physician needs to reduce the amniotic fluid."

Diagnosis codes: You should submit 657.03 (Polyhydramnios; antepartum condition or complication) on your claim. "You should report the polyhydramnios because that is what the physician is treating," says Pat Larabee, CPC, CCP-P, coding specialist for InterMed in South Portland, Maine.

You could also include 651.03 (Twin pregnancy; antepartum condition or complication) as a secondary diagnosis to add to the story, Smith says.

Procedure codes: You should report 59001 (Amniocentesis; therapeutic amniotic fluid reduction [includes ultrasound guidance]). Your physician removed large amounts of amniotic fluid for massive polyhydramnios or for twin-twin transfusion syndrome.

Watch out: You should not report 59000 (Amniocentesis; diagnostic). This code represents amniocentesis for diagnostic purposes. "You should not report this code for a fluid-reduction procedure," Smith says.

You would also not report the ultrasound guidance separately because this is clearly included as part of the procedure, as described by 59001. You may, however, report additional ultrasounds (other than the guidance) but only if your ob-gyn addresses problems (unrelated to the amniocentesis) that are affecting the mother or fetus, Smith adds.