How To Use CPT Code 59000

CPT 59000 describes the procedure of amniocentesis, which involves the insertion of a needle through the patient’s abdominal wall into the fetal amniotic sac to withdraw fluid for testing. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 59000?

CPT 59000 is used to report the procedure of amniocentesis, which is performed to withdraw amniotic fluid from the amniotic sac surrounding the fetus. This procedure involves the insertion of a needle through the patient’s abdominal wall, guided by ultrasound imaging, to access the amniotic sac and collect a sample of fluid for diagnostic testing.

2. Official Description

The official description of CPT code 59000 is: ‘Amniocentesis; diagnostic.’

3. Procedure

1. The provider prepares the patient’s abdominal area and drapes it to maintain a sterile environment.
2. Using ultrasound guidance, the provider identifies the optimal site for needle insertion into the amniotic sac.
3. Slowly and carefully, the provider inserts a needle through the abdominal wall and into the amniotic sac.
4. An assistant attaches the needle to tubing, which is connected to a drainage system.
5. Under continuous ultrasound guidance, the provider withdraws an appropriate amount of amniotic fluid for diagnostic testing.
6. Once the procedure is complete, the provider removes the needle slowly and cautiously.

4. Qualifying circumstances

Amniocentesis is typically performed for diagnostic purposes in pregnant patients who require further evaluation of fetal health or genetic abnormalities. It may be recommended for patients with advanced maternal age, abnormal prenatal screening results, a family history of genetic disorders, or other specific indications determined by the healthcare provider. The procedure should be performed by a qualified healthcare professional with expertise in amniocentesis.

5. When to use CPT code 59000

CPT code 59000 should be used when reporting the diagnostic procedure of amniocentesis. It is important to ensure that the procedure is performed solely for diagnostic purposes and not for therapeutic interventions. The code should be used when the provider performs the complete procedure, including the insertion of the needle into the amniotic sac and the withdrawal of amniotic fluid for diagnostic testing.

6. Documentation requirements

To support a claim for CPT code 59000, the healthcare provider must document the following information:

• Indication for the procedure, including the specific reason for performing amniocentesis
• Details of the procedure, including the use of ultrasound guidance and any complications encountered
• Amount of amniotic fluid withdrawn for diagnostic testing
• Any additional findings or observations made during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 59000, it is important to ensure that the procedure is performed solely for diagnostic purposes. If ultrasound guidance is used during the procedure, it should be reported separately using the appropriate ultrasound guidance code. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines to ensure accurate and appropriate reimbursement for the procedure.

8. Historical information

CPT code 59000 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A pregnant patient of advanced maternal age undergoes amniocentesis to assess the risk of chromosomal abnormalities in the fetus.
2. Amniocentesis is performed on a patient with abnormal prenatal screening results to further evaluate the presence of genetic disorders.
3. A pregnant patient with a family history of a specific genetic disorder undergoes amniocentesis to determine if the fetus is affected.
4. Amniocentesis is performed on a patient with a previous child affected by a genetic disorder to assess the risk of recurrence in the current pregnancy.
5. A pregnant patient with a suspected fetal infection undergoes amniocentesis to obtain amniotic fluid for culture and diagnostic testing.
6. Amniocentesis is performed on a patient with a history of preterm labor to assess fetal lung maturity and determine the appropriate management.
7. A pregnant patient with a suspected fetal hematologic disorder undergoes amniocentesis to obtain amniotic fluid for further evaluation and diagnosis.
8. Amniocentesis is performed on a patient with a suspected fetal urinary tract abnormality to obtain amniotic fluid for analysis and determine the appropriate management.
9. A pregnant patient with a history of recurrent pregnancy loss undergoes amniocentesis to assess for chromosomal abnormalities and potential causes of the losses.
10. Amniocentesis is performed on a patient with a suspected fetal cardiac abnormality to obtain amniotic fluid for genetic testing and further evaluation.