Fetal Laser and Surgery
Twin to twin transfusion syndrome (TTTS) is one of the most challenging clinical problems in monochorionic multifetal gestations with mortality rates as high as 80% if left untreated. Fetoscopic laser photocoagulation is described as the preferred method of treatment for select or severe cases of TTTS. The procedure stops the transfer of blood between fetuses, often halting the progression of the syndrome. Thorough evaluation, which includes obstetrical ultrasound and fetal echocardiography are often conducted and staged according to Quintero staging system. This will help determine if surgery will be appropriate before deciding if fetoscopic laser photocoagulation is an appropriate option. Generally, the procedure is performed between 16 and 26 weeks of gestation when no other significant fetal abnormalities are present, and when the pregnant mother is healthy and has a normal cervical length.
Billing for this service has been challenging because a specific CPT® code is not available for the procedure prompting the use of the unlisted procedure codes, many of which being unrecognized by many payers. The unlisted code 59897 Unlisted fetal invasive procedure, including ultrasound guidance, when performed is often used and continues to be recognized by certain payers. The disadvantage of reporting unlisted codes include the need to drop the claim to paper and attaching the operative report, getting the paperwork to the payer in a limited time frame, with the risk of claim loss and reimbursement delays. However, some payers continue to recognize the unlisted code but do not recognize S2411.
If the payer recognizes S2411 Fetoscopic laser therapy for treatment of twin-to-twin transfusion syndrome, it should be utilized since it has become the better option to report this service. The detailed description of S2411 reflects the fetal laser procedure in its entirety. Therefore, the code often has a fee schedule assignment, and will not require dropping the claim to paper with its associated delays.As always, please check with your local payers for their preferred method of reporting this service.
REFERENCES
Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M: Staging of twin-twin transfusion syndrome. J Perinatol 1999;19:550-555.• Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y: Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome.