Ob-Gyn Coding Alert

Question: Is 59866 the correct CPT code to use when one fetus of a twin pregnancy has an anomaly and that fetus will be terminated via potassium chloride injection? My concern is that this is selective reduction to terminate the one fetus with an anomaly, not necessarily to increase the viability of the remaining fetus. Also, can we separately bill ultrasound guidance for needle placement (76942) with 59866?

Alabama Subscriber

Answer: Although ob-gyns associate this procedure with fetal reduction to increase viability of the remaining fetuses, the technique for selective reduction is exactly the same. The physician uses an ultrasound-guided amniocentesis-like procedure to inject potassium chloride into the fetal heart to stop it. Therefore, you should report 59866 (Multifetal pregnancy reduction[s] [MPR]) in this instance. You will link it to the code for the fetal anomaly you are dealing with (655 category codes).

Code 59866 has a zero-global day period and does not include subsequent hospital visits or delivery of the fetus and secundines.

After the procedure, you will code the remaining fetus as 651.3x (Twin pregnancy with fetal loss and retention of one fetus). 

Beware: You would not bill for ultrasound guidance separately. Using 59850 (Induced abortion, by one or more intra-amniotic injections [amniocentesis-injections], including hospital admission and visits, delivery of fetus and secundines) would not be correct because you should use that code only for the abortion of the entire pregnancy.