How to report two different types of multi-fetal reductions and their respective approach
A recent question was asked on the correct way to report an Umbilical Cord Occlusion via the Radio Frequency Ablation approach”. Below you will find two examples of multi-fetal reductions, their approach and correct coding guidance for billing purposes.
Types of Fetal Reductions and their approaches:
1. Selective Multi-Fetal Reduction: Multi-fetal pregnancy reduction (MFPR) is a procedure used to reduce the number of fetuses in a multiple pregnancy. Assisted reproductive technology (ART) and fertility drugs have greatly increased the number of multiple pregnancies. The goal of MFPR is to increase the chance of a successful and healthy pregnancy. MFPR is usually done early in a pregnancy, between the 11th and 13th weeks. It is most often done when there are three or more fetuses present but can be used to reduce twins to a singleton and is known as "selective reduction" (SR) when it involves a fetus with anomalies or one that is expected to die later in the pregnancy and threatens the life of the surviving fetus or fetuses. The most common method of fetal reduction is trans-abdominal MFPR. For this procedure, the doctor uses ultrasound guidance to insert a needle through the woman's abdomen into the thorax of the selected fetus(es). The doctor then injects a concentrated potassium solution which stops the fetal heart immediately. Complications following intra-cardiac injection of potassium for MFPR/SR are rare. This method of MFPR/SR is contraindicated in pregnancies where there is only one placenta (mono-chorionic) due to the presence of vascular communications between the fetuses and subsequent risk of transfer of medication or blood loss from one fetus to the other when there is a fetal death.
Correct coding guidance to report a Selective Multi-Fetal Reduction under ultrasound guidance is:
59866 Multi-fetal pregnancy reduction(s) (MPR)
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
Some payers will require the Modifier “59” appended on the ultrasound guidance scan for payment. Please check with your local payers for their preferred method of reporting these services.
2. Umbilical Cord Occlusion via Radio Frequency Ablation: Radio-frequency ablation (RFA) is a procedure that utilizes thermal energy to stop the blood flow in umbilical vessels in a complicated mono-chorionic (MC) multi-fetal pregnancy for selective reduction due to discordant malformations, severe fetal growth restriction, twin-twin transfusion syndrome or twin reverse arterial perfusion (TRAP) sequence. It uses a small needle device that is inserted under ultrasound guidance to the insertion of the umbilical cord of the affected fetus. The radiofrequency current is applied until there is arrest of blood flow in the umbilical vessels. Thermal occlusion is used in complicated MC instead of other means of selective reduction, such as injection of medications, to reduce the risk of compromise to the unaffected co-twin from transfer of medications or blood loss through the placental vascular communication between the fetuses that are present in MC placentas. The advantage of the RFA when compared to bipolar forceps, an alternate means of thermal occlusion of umbilical cord vessels, is the that the RFA needle is smaller than the bipolar forceps. The smaller size is felt to minimize maternal morbidity and the risk of postoperative complications such as preterm rupture of membranes when compared to other techniques for umbilical vessel occlusion. The remains of the abnormal fetus will be compressed from the growth of the surviving fetus(es) as the pregnancy progresses and pass during delivery.
Correct coding guidance to report a SINGLETON fetal reduction when the approach is umbilical cord occlusion via radiofrequency ablation under ultrasound guidance is:
59072 Fetal umbilical cord occlusion, which includes ultrasound guidance if performed on one fetus