Ob-Gyn Coding Alert

Question: I know we can report amniocentesis for twins several ways, based on CPT Assistant. I've heard the best way is to report the amnio twice if the ob-gyn needed to use two sticks; otherwise, we should simply append modifier 22. But should we report two units of 76946 when we report only one unit of 59000 for twins?

Nebraska Subscriber

Answer: You should report ultrasound guidance only once (76946, Ultrasonic guidance for amniocentesis, imaging supervision and interpretation), as your ob-gyn uses it throughout the entire procedure. Even if the ob-gyn did two amnios, you will still report the guidance only once.

In some instances, twins can have two amniotic sacs. When that is the case, you may report 59000 (Amniocentesis; diagnostic) twice, one time for each sac. If the twins are identical (share the amniotic sac), then you can report 59000 only once.

Warning: You should not add modifier 22 (Increased procedural service) to a single amnio procedure, even with twins. You might apply modifier 22 to 59000 in these circumstances: your ob-gyn performed an amniocentesis on two amniotic sacs and the payer rejects billing 59000 twice the ob-gyn has documented significant increased work due to the presence of twins, or the patient has a higher multiple gestation pregnancy.

-- The answers for Reader Questions and You Be the Coder provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.