Radiology Coding Alert

Question: In a patient with a rapidly increasing uterine size at 22 weeks gestation, limited ultrasound scanning revealed the presence of a twin gestation. One twin was small for gestational age and had oligohydramnios. The other twin is appropriate for gestational age and had severe polyhydramnios. The documented diagnosis was polyhydramnios and twin perfusion. Our physician did an amniotic fluid reduction. He performed real-time ultrasound scanning to identify the sac with increased amniotic fluid. Using continuous ultrasonic guidance, he removed the fluid until the ultrasound confirmed normal amounts of fluid. The procedure was completed with continual monitoring of the needle location to avoid injury to the fetus or placenta since the removal of fluid alters the uterine shape. How can we bill for this procedure?

New York Subscriber

Answer: You should report 59001 (Amniocentesis; therapeutic amniotic fluid reduction [includes ultrasound guidance]). Your physician removed large amounts of amniotic fluid for massive polyhydramnios or for twin-twin transfusion syndrome.

Not diagnostic: You should not report 59000 (Amniocentesis; diagnostic). This code represents amniocentesis for diagnostic purposes. You should not report this code for a fluid-reduction procedure.

USG guidance is inclusive: You would also not report the ultrasound guidance separately because this is clearly included as part of the procedure, as described by 59001. You may, however, report additional ultrasounds (other than the guidance) but only if your physician addresses problems (unrelated to the amniocentesis) that are affecting the mother or fetus.

Diagnosis codes: You should submit O40.2xx1 (Polyhydramnios, second trimester, fetus 1) on your claim. You should report the polyhydramnios because that is what the physician is treating. You could also include O30.042 (Twin pregnancy, dichorionic/diamniotic, second trimester) as a secondary diagnosis to add to the story. And don’t forget to also report Z3A.22 (22 weeks gestation of pregnancy).