How To Use CPT Code 59897

CPT 59897 describes an unlisted fetal invasive procedure, including ultrasound guidance, when performed during maternity care and delivery. 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 59897?

CPT 59897 can be used to report a fetal invasive procedure that is not represented by any specific code in maternity care and delivery. This code is used when the provider performs a procedure on a pregnant patient or during delivery that does not have a designated code. Ultrasound guidance is typically involved in this surgery, and a transabdominal approach is commonly used.

2. Official Description

The official description of CPT code 59897 is: ‘Unlisted fetal invasive procedure, including ultrasound guidance, when performed.’

3. Procedure

1. The provider performs a fetal invasive procedure on a pregnant patient or during delivery.
2. The procedure may involve the use of ultrasound guidance to view internal tissues and guide the intervention.
3. A transabdominal approach is typically used for this surgery.
4. The procedure is not represented by any specific code in maternity care and delivery.

4. Qualifying circumstances

CPT 59897 is used when the provider performs a fetal invasive procedure during maternity care and delivery that does not have a specific code. This code is used for procedures that are not covered by any other active codes. It is important to note that ultrasound guidance is typically involved in this surgery, and a transabdominal approach is commonly used.

5. When to use CPT code 59897

CPT code 59897 should be used when the provider performs a fetal invasive procedure during maternity care and delivery that does not have a specific code. It is important to ensure that there is no other active code available that accurately represents the service provided. If a Category III code is available for the procedure, it should be reported instead of using an unlisted procedure code.

6. Documentation requirements

To support a claim for CPT 59897, the provider must document the following information:

• A detailed description of the procedure performed
• The reason for choosing the unlisted code instead of a defined, active code
• Comparison to similar codes to justify the claim amount
• Operative notes or other relevant documentation to strengthen the claim

7. Billing guidelines

When billing for CPT 59897, it is important to include a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. The cover letter should also include one or more similar codes and compare the service to those codes to justify the claim amount. Additionally, the provider should include the operative notes or other relevant documentation to strengthen the claim and avoid a possible denial. Payers will consider claims with unlisted procedure codes on a case-by-case basis and determine payment based on the documentation provided.

8. Historical information

CPT 59897 was added to the Current Procedural Terminology system on January 1, 2004. It was initially described as an unlisted fetal invasive procedure, including ultrasound guidance. There have been no updates to the code since its addition.

9. Examples

1. A provider performs an unlisted fetal invasive procedure, including ultrasound guidance, during a patient’s delivery to address a specific condition.
2. During maternity care, a provider performs a fetal invasive procedure using ultrasound guidance to diagnose and manage a complex fetal condition that does not have a specific code.
3. A patient requires a fetal invasive procedure during delivery, and the provider uses ultrasound guidance to guide the intervention and ensure the best possible outcome.
4. A provider performs an unlisted fetal invasive procedure, including ultrasound guidance, during a patient’s pregnancy to address a unique fetal condition that does not have a designated code.
5. During maternity care, a provider performs a fetal invasive procedure using ultrasound guidance to treat a rare fetal condition that is not covered by any other active codes.
6. A patient undergoes a fetal invasive procedure during delivery, and the provider utilizes ultrasound guidance to ensure the procedure is performed accurately and safely.
7. A provider performs an unlisted fetal invasive procedure, including ultrasound guidance, during a patient’s pregnancy to address a complex fetal condition that requires specialized intervention.
8. During maternity care, a provider performs a fetal invasive procedure using ultrasound guidance to manage a rare fetal condition that does not have a specific code.
9. A patient requires a fetal invasive procedure during delivery, and the provider uses ultrasound guidance to guide the intervention and optimize the outcome.
10. A provider performs an unlisted fetal invasive procedure, including ultrasound guidance, during a patient’s pregnancy to address a unique fetal condition that is not represented by any other specific code.