Ob-Gyn Coding Alert

Question: Our problem is with code 76946 (ultrasonic guidance for amniocentesis, radiological supervision and interpretation). Code 76947, which was a bundling, has now been dropped and replaced with 76946 and 59000 (amniocentesis, any method) to be billed separately. However, insurance companies still bundle these as they state ultrasonic guidance is an incidental procedure. Our argument is that the procedure is necessary for the safety of the fetus and therefore not incidental. Since the codes are now split, we are baffled as to why we continue to fight for this payment. What advice do you have?

Marlene J. Hockema, Business Administrator
Fetal Diagnostic Center, PC, Eugene, OR

Answer: The code 76947 was deleted from CPT in 1992. That code, which represented an amniocentesis using ultrasound guidance by one physician, was separated into its two components (76946 and 59000) because in some instances, both the ob/gyn and the radiologist perform a part of the service. When one physician performs both the amnio procedure and performs the ultrasound guidance, both codes can be correctly reported. You should point out to the payer that to safely perform amniocentesis, ultrasound guidance during the actual procedure is also necessary. This requires an additional ultrasonographer along with the physician performing the amniocentesis. The ultrasound guidance serves two purposes: 1) it allows the physician to safely guide the needle into the pocket of amniotic fluid while avoiding the fetus, and 2) it provides a continuous monitoring of the position of the needle in relation to the fetus while withdrawing the amniotic fluid.