CPT® Code 36460

Official Description

Transfusion, intrauterine, fetal

Common Language Description

The CPT® Code 36460 refers to the procedure of intrauterine fetal transfusion, which is a critical intervention performed during pregnancy. This procedure is primarily indicated when there is a risk to the fetus due to conditions such as Rh incompatibility, where the mother's immune system attacks the fetal red blood cells, particularly in cases involving an Rh-positive fetus. Another significant indication for this transfusion is neonatal alloimmune thrombocytopenia (NAIT), a condition that arises when maternal antibodies target specific antigens on the fetal platelets, leading to a decrease in platelet count and potential complications for the fetus. Prior to conducting the transfusion, a thorough abdominal ultrasound is performed to assess the fetal position, locate the placenta, and identify the umbilical vein, as well as to evaluate the levels of amniotic fluid. This imaging is crucial for ensuring the safety and accuracy of the procedure. Continuous ultrasound monitoring is employed to guide the placement of the needle into the umbilical vein at the site of placental insertion, although in some cases, the needle may be inserted directly into the fetal abdomen. The transfusion itself involves administering blood to the fetus, and both the mother and fetus are closely monitored throughout the procedure and during the recovery period to ensure their well-being and to manage any potential complications that may arise.

1. Indications

The procedure of intrauterine fetal transfusion (CPT® Code 36460) is indicated for specific medical conditions that pose risks to the fetus. The following are the primary indications for performing this procedure:

Rh Incompatibility - This condition occurs when an Rh-positive fetus is at risk due to the mother's immune system producing antibodies that destroy fetal red blood cells.
Neonatal Alloimmune Thrombocytopenia (NAIT) - This condition is caused by maternal antibodies that target platelet-specific antigens, leading to a decrease in the fetal platelet count and potential complications.

2. Procedure

The intrauterine fetal transfusion procedure involves several critical steps to ensure the safety and effectiveness of the intervention. The following outlines the procedural steps:

Step 1: Pre-Procedure Ultrasound - An abdominal ultrasound is performed to assess the position of the fetus, locate the placenta, and identify the umbilical vein. This imaging also evaluates the level of amniotic fluid, which is essential for determining the appropriate approach for the transfusion.
Step 2: Continuous Ultrasound Monitoring - During the transfusion, ultrasound imaging is used continuously to monitor the proper placement of the needle. This ensures that the needle is accurately inserted into the umbilical vein at the placental insertion site, which is critical for the success of the transfusion.
Step 3: Needle Insertion - The procedure may involve inserting the needle into the umbilical vein; alternatively, the needle may be inserted directly into the fetal abdomen, depending on the clinical situation and ultrasound findings.
Step 4: Blood Transfusion - The actual transfusion of blood is performed, providing the necessary red blood cells to the fetus to address the identified condition.
Step 5: Monitoring - Both the mother and fetus are closely monitored throughout the transfusion procedure and during the recovery period to ensure their safety and to manage any potential complications that may arise.

3. Post-Procedure

After the intrauterine fetal transfusion, careful monitoring of both the mother and fetus is essential. This includes observing for any immediate complications that may occur as a result of the procedure. The healthcare team will assess the fetal heart rate and maternal vital signs to ensure stability. Additionally, follow-up ultrasounds may be performed to evaluate the effectiveness of the transfusion and to monitor the condition of the fetus. The overall recovery process will depend on the individual circumstances of the mother and fetus, and appropriate medical care will be provided as needed.

Short Descr	INTRAUTERINE TRANSFUSION FTL
Medium Descr	TRANSFUSION INTRAUTERINE FETAL
Long Descr	Transfusion, intrauterine, fetal
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P2F - Major procedure, cardiovascular-Other
MUE	2
CCS Clinical Classification	141 - Other therapeutic obstetrical procedures

Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).

Left side (used to identify procedures performed on the left side of the body)