Ob-Gyn Coding Alert

CPT 2004 code changes provide needed specificity for fetal surgeries and continue the trend to delete "separate procedure" designations. 4 New Fetal Surgery Codes The "Maternity Care and Delivery" section includes four new codes for fetal intrauterine surgical procedures and a new unlisted-procedure code that should make life easier for many ob-gyn and maternal fetal medicine coders. Tip: Notice that all of the new codes include ultrasound guidance, so you shouldn't add a second code from CPT's radiology section for this procedure, says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.
 
CPT 2004 adds 59070 (Transabdominal amnioinfusion, including ultrasound guidance) because this procedure requires more work than an amniocentesis (59000*, Amniocentesis; diagnostic). Ob-gyns perform this procedure when amniotic fluid is low so that they can more clearly evaluate fetal anatomy. They also usually perform it before an invasive procedure, such as fetal shunts, to permit proper instrument placement.
 
When your ob-gyn treats patients carrying monochorionic twins and one of the twins has a severe fetal anomaly, you will be able to use new code 59072 (Fetal umbilical cord occlusion, including ultrasound guidance). In this procedure, the surgeon occludes the blood flow from the umbilical cord going to the affected fetus using laser, suture or bipolar coagulation. He also uses ultrasound, including color Doppler, to confirm complete absence of flow through the occluded cord. An ob-gyn also might use this procedure "in a case of twin-twin transfusion syndrome," says Harry L. Stuber, MD, an independent gynecologist based in Cookeville, Tenn.
 
CPT also introduces 59074 (Fetal fluid drainage [e.g., vesicocentesis, thoracocentesis, paracentesis], including ultrasound guidance). You would use this code when the surgeon aspirates fluid from fetal body cavities or organs for either diagnostic or therapeutic purposes to evaluate and/or treat congenital abnormalities, Witt says. For instance, report 59074 for fetal bladder aspiration, she notes. In that case, the ob-gyn directs a needle into the fetal bladder and aspirates fetal urine.
 
New code 59076 (Fetal shunt placement, including ultrasound guidance) describes a fetal shunt placement such as when the physician percutaneously inserts a double pigtailed catheter into the space that requires drainage. Once the catheter is in place in the fetal bladder (or in the thorax if the problem is pleural effusion), the surgeon places the other end into the amniotic cavity so the fluid can go into this space.
 
And finally, CPT 2004 adds 59897 (Unlisted fetal invasive procedure, including ultrasound guidance) for unlisted fetal surgery procedures not covered by 59070-59076. Generally, a maternal fetal medicine specialist will be using these codes, Stuber says.
 
Update Terminology for Sonograms The new CPT also revises 58340 (Catheterization and introduction of saline or contrast material for saline infusion sonohysterography [SIS] or hysterosalpingography) [...]