Ob-Gyn Coding Alert

Many ob/gyn practices question how to correctly code and bill for amniocentesis when there are twins or triplets. The ingredients for optimal reimbursement lie in first understanding the procedures involved, the CPT coding choices and the diagnostic information that will support medical necessity for the procedures. Coding for multiple gestation then becomes a matter of numbers.

Amniocentesis can be defined as the transabdominal removal of fluid from the amniotic sac. The fluid is pathologically evaluated for genetic studies or to assess fetal lung maturity. The most advantageous time to do amniocentesis is at 16 weeks gestation. Direct ultrasound visualization helps the physician to precisely locate the area for obtaining fluid. Using ultrasound guidance, the amniotic sac is visualized, taking care to avoid passage through the placenta. Using a 20 to 22 gauge needle, 10 to 20 milliliters of fluid is withdrawn. The physician assesses the fetal heart tones at the end of the procedure.

CPT Coding for Amniocentesis

Even when the ob/gyn is providing global obstetrical services, amniocentesis is always a separately billable service. (See your CPT manual for a definition of the items included in the global obstetrical package.) There are individual CPT codes describing the amniocentesis procedure (59000) and ultrasonic guidance for amniocentesis (76946).

When the ob/gyn is performing both the amniocentesis and the ultrasound guidance, each of the above codes should be submitted on the claim. If the procedure is followed by a limited ultrasound to assess fetal heart tones, code 76815 (ultrasound, limited [fetal heart beat...]) can also be reported. If a radiologist is utilized to provide the ultrasonic guidance (and possibly the limited ultrasound), the ob/gyn will only bill for the amniocentesis. Note that a modifier -26 (professional component) would be added to each of the ultrasound procedure codes reported by the ob/gyn if the procedure is not performed in his or her office. This is because an ultrasound code submitted with no modifier implies that the physician used his or her own equipment to perform the procedure. In a setting other than the physicians office, the facility normally bills separately for the technical component of the service.

Coding for Multiple Gestation

For multiple gestation, the CPT codes submitted will depend on the method used for the procedure, says Melanie Witt, RN, CPC, MA, program manager for the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists. Generally, each amniotic sac is aspirated. This can be accomplished by using dye to distinguish the two individual needle sticks. Amniocentesis of a twin gestation can also be done by first inserting the needle into the most proximal sac, then traversing the needle through the dividing membrane and aspirating the second sac.

If separate needle sticks [...]