CPT® Code 59076

1. Indications

The fetal shunt placement procedure is indicated for specific conditions that necessitate intervention to alleviate fluid accumulation in the fetus. The following are the primary indications for this procedure:

• Pleural Effusion - This condition involves the accumulation of excess fluid in the fetal thorax, which can lead to respiratory complications and other issues if not addressed.
• Bladder Obstruction - In this scenario, fluid builds up in the fetal bladder due to an obstruction, which can result in significant complications for the developing fetus if not managed appropriately.

2. Procedure

The procedure for fetal shunt placement involves several critical steps to ensure successful intervention. Each step is performed with precision and under continuous ultrasound guidance to ensure the safety and effectiveness of the procedure.

• Step 1: Preparation - The physician begins by selecting a suitable shunt and sterilizing it along with the necessary insertion instruments. This step is crucial to prevent any risk of infection during the procedure.
• Step 2: Anesthesia Administration - A local anesthetic is administered to the maternal abdominal wall and fascia to minimize discomfort during the procedure. This ensures that the mother remains comfortable while the procedure is being performed.
• Step 3: Trocar Insertion - Using continuous ultrasound guidance, a trocar is carefully inserted into the maternal abdomen and uterus, advancing it into the fetal thorax or bladder. This step requires precision to ensure that the trocar is correctly positioned.
• Step 4: Catheter Placement - A catheter is then passed through the trocar, with the proximal end being advanced into the fetus' thorax or bladder. This is a critical step as it establishes the conduit for fluid drainage.
• Step 5: Distal Portion Placement - The trocar is withdrawn slightly to allow for the placement of the distal portion of the catheter into the amniotic cavity. This ensures that the fluid can be effectively drained from the thorax or bladder into the amniotic space.
• Step 6: Confirmation of Placement - Correct placement of the conduit is confirmed using ultrasound imaging, which is essential to ensure that the shunt is functioning as intended.
• Step 7: Trocar Removal and Monitoring - After confirming proper placement, the trocar is removed, and both the patient and fetus are monitored as needed to assess the outcomes of the procedure.
• Step 8: Additional Imaging - Additional imaging may be obtained to verify that the thorax or bladder is draining properly, ensuring that the procedure has achieved its intended effect.
• Step 9: Discussion and Reporting - Finally, the physician discusses the results of the procedure with the patient and prepares a written report detailing the intervention and its outcomes.

3. Post-Procedure

Post-procedure care involves monitoring the patient and fetus to ensure that there are no immediate complications following the shunt placement. The physician may conduct follow-up imaging to confirm that the thorax or bladder is draining effectively and that the fetus is stable. It is essential to observe for any signs of distress or complications that may arise after the procedure. The physician will also discuss the results of the procedure with the patient, providing information on the next steps and any necessary follow-up care. Documentation of the procedure and its outcomes is crucial for medical records and future reference.