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) to reflect more current terminology. The term "hysterosonography" has been changed to "saline infusion sonohysterography (SIS)." A similar terminology change applies to the radiological supervision code 76831 (Saline infusion sonohysterography [SIS], including color flow Doppler, when performed). This change does not in any way alter how you should use the codes, Witt says.

Use 53500 for Obstructive Voiding
 
You should use new code (53500, Urethrolysis, transvaginal, secondary, open, including cystourethro-scopy [e.g., postsurgical obstruction, scarring]) to report the treatment of obstructive voiding when periurethral scarring causes it. This scarring can occur postoperatively following a urethral suspension procedure such as a bladder neck suspension.
 
You can also use 53500 for an obstruction secondary to a collagen injection around the urethra that the physician performed previously for intrinsic sphincter deficiency, which is another kind of incontinence, Stuber notes.
 
During this procedure, the surgeon usually dissects, lyses and removes the periurethral scar tissue and mobilizes the urethra away from the surrounding tissues. He may also do a cystourethroscopy (52000, Cystourethroscopy [separate procedure]) after this procedure to check the urethra. Warning: If the surgeon performs the scope to check his work, however, you should not report 52000 separately from 53500, Stuber says.
 
On the other hand, if the doctor performs the urethrolysis via a retropubic rather than vaginal approach, CPT states that you would report it with the unlisted-procedure code (53899, Unlisted procedure, urinary system) instead.
 
Separate Procedures on the Way Out
 
CPT 2004 deletes the term "separate procedure" from two of the skin biopsy codes: 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and 11101 (... each separate/additional lesion [list separately in addition to code for primary procedure]). This is part of an ongoing effort to eliminate this designation for all codes in the CPT manual, Witt says.
 
A new guideline added just before 11100, however, seeks to ensure that you report these biopsy codes only under the correct circumstances. That is, you should submit 11100-11101 only when the skin biopsy is an unrelated, distinct procedure from the other skin surgery the ob-gyn performs at the same session. If the surgeon removes tissue and sends it to pathology in the course of performing a distinct skin procedure, you should consider these services integral to the reported procedure and not bill for them separately, Witt says.