KCL Procedure MFM billing options when CPT code 59897 is not reimbursed
Performance of KCL intramniotic/intracardiac injection to arrest the fetal heart, prior to a termination procedure is a coding challenge. Common MFM practice is to provide the KCL injection into the fetal heart with ultrasound guidance only in the office or pre-operatively. In the majority of cases, the referring provider then completes the termination procedure, rather than the MFM. When the patient elects this procedure, real-time ultrasound guidance is used to inject 3-5 mL of potassium chloride (2 mEq/mL) directly into the fetal cardiac chambers, followed by observation of fetal heart activity to ascertain cessation. There is NO specific code for this procedure. We recommend that you bill: 59897 - unlisted fetal invasive procedure, including ultrasound guidance (Claim should be dropped to paper with supporting documentation). In the rare instances that this procedure is NOT reimbursed appropriately, then we recommend you check with your payer for their preferred method to report this service. Alternative work-arounds, directed by the payer ,may include: billing 59000 (amniocentesis) with 76946 (ultrasound guidance for this procedure); or billing 76942 (ultrasound guidance for needle placement, imaging, supervision) only. While not ideal, and not preferred by the SMFM Coding committee, these may be options that are acceptable to the payer as the payment is aligned with the service being provided. In all billing scenarios with this procedure, the supplies used (KCL, needles, drapes, gloves, cleaning solution etc) are included in all the procedure codes and can NOT be billed separately or in addition. In the case that the same MFM is providing the intra-amniotic injection, hospital admission and delivery/termination, we recommend billing one of the appropriate comprehensive codes 59850-59852.