Patricia Posted Thu 23rd of April, 2020 11:26:31 AM
I have a situation where the pregnancy was affected by lethal fetal anomaly and underwent termination of pregnancy via feticidal injection plus laminaria placement both performed at our MFM clinic. We will say Dr. A did this procedure. (Amino) on one day. The next day Dr. B performed at the hospital and D&E. Since there were two doctors different days How do we code. Diag is not important at this time. If the same physician had done both procedures I would have picked 59851.
SuperCoder Answered Fri 24th of April, 2020 10:42:08 AM
As per the coding guidelines, CPT 59851 is ‘Inpatient-Only Procedure Code’ and cannot be performed in clinical setting. CPT 59851 is global procedure where the provider terminates a pregnancy by injecting a saline solution into the amniotic sac to cause fetal demise, which in turn will usually begin the labor process. The provider admits the patient to the hospital, administers the intra amniotic injections, manages the labor that follows, and then performs a dilation and curettage. The provider then follows the patient in the hospital until discharge. Providers use this method usually after the first trimester, or fourteen weeks and zero days gestation or more. However, CPT 59851 has 90 days of global period, hence prior the day of surgery is inclusive in CPT 59851. So, the CPT 59851 will be billed only for Dr. B .
Hope this helps!
Patricia Posted Mon 27th of April, 2020 06:55:40 AM
Is there any other way to code so that both Physicians can bill?
SuperCoder Answered Tue 28th of April, 2020 12:11:06 PM
As per the CPT guidelines, CPT 59851 can only bill if performed in hospital setting.
There are procedures where two providers work as primary surgeons, and each performs part of a procedure, modifier 62 is appended for the same procedure code for each surgeon. Each surgeon reports the same procedure code to the payer, appending modifier 62 to the code. Medicare reimburses each provider a percentage of the Medicare global surgery fee schedule amount for the procedure. Each provider must clearly document the components of the surgery he performed.
Unfortunately, you cannot even use modifier 62 for CPT 59851 because modifier 62 is not applicable for 59851.
The reimbursement of CPT 59851 can be share between Dr. A and Dr. B by their mutual consent.
Hope this helps
Patricia Posted Tue 28th of April, 2020 13:31:33 PM
this was an outpatient proc is there another code to use? 4/15 was done in our MFM clinic Outpt. Amnio with feticide injection. on 4/16 the Dilation and evacuation was done as an outpatient. Maybe I am not asking question correctly. I can code an D&E for the 16th. I do not what to code for the injection? The D&E could be 59841?
SuperCoder Answered Wed 29th of April, 2020 12:11:06 PM
We are working on your query, will get back to you soon.
SuperCoder Answered Thu 30th of April, 2020 12:00:57 PM
Thanks for your query.
There is no specific CPT code for Amnio with feticide injection procedure for outpatient services. The intra-amniotic injections procedure is coded with 59850 which is an ‘Inpatient-Only Procedure Code’.
As per the provided documentation, Dr. A has performed feticidal injection plus laminaria placement both performed at MFM clinic. There is a code for laminaria placement which is 59200 [Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)] which you can code for Dr. A for 4/15. You can add modifier 22 (Increased Procedural Services) with CPT 59200 for amnio with feticide injection service. Also add the copy of operative report with the bill to justify the claim.
If Dr. B has performed only dilation and evacuation on 4/16 as an outpatient than code 59841 will be appropriate.
Hope this helps!