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Understand why reporting ultrasound guidance is a mistake.

When an amniocentesis claim lands on your desk involving polyhydramnios and twin-twin transfusion syndrome (TTTS), do you know what to do?

Follow these three steps when coding this amnio procedure and see if you鈥檙e on par with our coding recommendations.

Step 1: Carefully Read This Note

The ob-gyn sees a patient with a rapidly increasing uterine size at 22 weeks gestation.

Limited ultrasound (US) scanning reveals the presence of a twin gestation. One twin is small for gestational age and has oligohydramnios. The other twin is appropriate for gestational age but has severe polyhydramnios.

The ob-gyn makes a diagnosis of TTTS and counsels the patient as to the available therapies. The patient elects amniotic fluid reduction. The ob-gyn explains the risks and benefits of the procedure.

The physician performs real-time US scanning to identify the sac with increased amniotic fluid. The physician drapes and preps the area. Then they identify the needle insertion site. Under real-time US guidance, the provider inserts a 22-gauge needle into the amniotic sac.

The ob-gyn then attaches the needle to a drainage system. Using continuous ultrasonic guidance, they remove the fluid until they see a normal amount of fluid on the US.

The physician remains in constant communication with the US operator regarding the status of both fetuses and the fluid level; this continual monitoring of the needle location is required to avoid injury to the fetus or placenta since the removal of fluid alters the uterine shape.

Once the patient has a normal fluid level, the physician removes the needle.

Step 2: Pull Out Key Terms and Codes

The key term to look for is 鈥減olyhydramnios,鈥� experts say. This term indicates the physician needs to reduce the amniotic fluid.

Diagnosis codes: As this procedure is being performed at 22 weeks gestation (second trimester), you should submit O40.2XX0 (Polyhydramnios, second trimester, not applicable or unspecified). You should report the polyhydramnios because that is what the physician is treating. In addition, you should also report O43.022 (Fetus-to-fetus placental transfusion syndrome, second trimester) to complete the picture.

You could also include a code from the O30.0- (Twin pregnancy) category as a secondary diagnosis to add to the story.

Procedure codes: Your physician removed large amounts of amniotic fluid for massive polyhydramnios or for TTTS. That means you should report 59001 (Amniocentesis; therapeutic amniotic fluid reduction (includes ultrasound guidance)).

Step 3: Avoid These Mistakes

You might have considered reporting 59000 (Amniocentesis; diagnostic).

Why this is wrong: This code represents amniocentesis for diagnostic purposes. You should not report this code for a fluid-reduction procedure.

Did you consider reporting the US guidance separately?

Why this is wrong: US guidance is clearly included as part of the procedure described by 59001. You may, however, report additional ultrasounds, other than the guidance, but only if your ob-gyn addresses problems (unrelated to the amniocentesis) that are affecting the mother or fetus.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor