Ob-Gyn Coding Alert

Learn the new code's specific requirements to avoid miscoding

Before you report 59070, make sure you meet all the strict requirements associated with this code. Otherwise, you might be refiling the claim.

CPT 2004 introduced 59070 (Transabdominal amnioinfusion, including ultrasound guidance) as one of a series of new fetal surgery codes (59070-59076).

"My practice does the transabdominal amnioinfusion often," says Donna C. Kroening, CPC, reimbursement manager for the ob-gyn department at the Medical College of Wisconsin in Milwaukee. "We were very excited that the Society for Maternal-Fetal Medicine got the code in the CPT book, and I no longer have to use the unlisted code."

59070 Is Approach-Specific

According to the AMA's CPT Changes 2004: An Insider's View, ob-gyns use transabdominal amnioinfusion when amniotic fluid is low because the procedure allows the surgeon to add fluid so he or she can better evaluate fetal anatomy.

For example, a patient at 23 weeks of gestation presents with decreased amniotic fluid, which is uncovered by a routine ultrasound (for example, 76805, Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester [> or = 14 weeks 0 days], transabdominal approach; single or first gestation). The ob-gyn suspects fetal renal anomalies but cannot see the fetal anatomy because of the decreased fluid. Consequently, he performs a transabdominal amnioinfusion.

During this procedure, the surgeon performs an amniocentesis using ultrasonic guidance to place the needle between the fetal extremities. He then instills saline under continuous ultrasound until he can adequately visualize the fetal anatomy. He then removes the needle.

Be prepared for carriers to deny the procedure if you report nonspecific diagnosis codes, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C. "List the procedure with the most accurate diagnosis codes to represent the problem, and do not list codes for this line item that are not applicable to the procedure." Generally, you would report reduced amniotic fluid as 658.0x (Oligohydramnios).

Use Unlisted Procedure for Transcervical Infusion

This may seem fairly straightforward. But what should you do when the ob-gyn infuses fluid transcervically?

During this procedure, the physician snakes a catheter through the vagina and cervix. He then uses it to add saline to better visualize the fetus with ultrasound.

Because the ob-gyn is not using a needle to add fluid through a transabdominal approach, 59070 is not an option for this procedure, Kroening says. Instead, you should report 59899 (Unlisted procedure, maternity care and delivery), she adds.

Unlisted-procedure codes require special care when you submit them. For more on what you can do to get these claims paid, see "Improve Your 'Unlisted Procedure' Pay With 4 Tips".