Ob-Gyn Coding Alert

Question: When my ob-gyn performs an amniocentesis in our facility using our equipment, I report 59000 and 76946 for ultrasound guidance. However, the new National Correct Coding Initiative (NCCI) version 10.3 edits say 76942 (Ultrasonic guidance for needle placement, imaging supervision and interpretation) "may be paid with modifier." What are the appropriate procedure codes to use?

Iowa Subscriber

Answer: You should use 59000 (Amniocentesis; diagnostic) and 76946 (Ultrasonic guidance for amniocentesis, imaging supervision and interpretation). You do not need any modifiers.

You should only use the needle placement code if the ob-gyn places the needle into a fetal structure.

In the case of amniocentesis, the ob-gyn only puts the needle into the fluid surrounding the baby, so 76946 is the most accurate accompanying code. 

Note: Some payers might try to bundle these two because 59001 (Amniocentesis; therapeutic amniotic fluid reduction [includes ultrasound guidance]) includes ultrasound guidance, but 59000 and 59001 are not the same procedure.

Code 59000 collects fluid for assessment, and 59001 removes a lot of fluid to relieve oligohydramnios.