adudms
Guest
I am currently involved in a dispute with an insurance company coder over the use of CPT 59897 and S2260 (state mandated code for abortion). As used at this office, 59897 is for a transabdominal or anterior fornix injection of digoxin into a fetus or amniotic fluid for the purpose of causing fetal demise prior to a second or third trimester abortion. This is done one to two days prior to the actual abortion to allow the drug to work and cause fetal tissue softening and therefore always billed on a different day of service from the abortion. The insurance coder is insisting the code is only reimbursable if done the same day as the abortion. I can find nothing in CCI edits, restrictions in the Professional CPT code book, or anywhere in an internet search that substantiates the coders claim. No other insurance company OR Medicaid denies our use of this code. Can anyone verify whether the insurance coder is correct, or is making an assumption based on incorrect or incomplete knowledge on how 59897 can be used? Thank you for any guidance anyone can give me!