CPT® Code 76941

Official Description

Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation

Common Language Description

Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, as described by CPT® Code 76941, involves the use of ultrasound technology to assist in specific medical procedures aimed at addressing fetal health concerns. This guidance includes both imaging supervision and interpretation, which are critical for ensuring the safety and accuracy of the procedures being performed. Intrauterine fetal transfusion is a therapeutic intervention indicated for fetuses that are at risk of anemia due to conditions such as Rh incompatibility, where the mother's immune system attacks the fetal red blood cells. Additionally, fetal transfusion may be necessary in cases of neonatal alloimmune thrombocytopenia, where maternal antibodies target fetal platelets, leading to potential complications. Cordocentesis, also known as percutaneous umbilical cord sampling, is another procedure performed under ultrasound guidance. It involves obtaining a blood sample from the fetus via the umbilical cord, which is essential for diagnosing various fetal conditions, including anomalies, infections, thrombocytopenia, anemia, or isoimmunization. Prior to conducting either procedure, an abdominal ultrasound is performed to assess the position of the fetus, locate the placenta, and identify the umbilical vein, as well as to evaluate the level of amniotic fluid. Continuous ultrasound imaging is utilized to ensure the accurate placement of the needle, whether it is inserted into the umbilical vein for cordocentesis or into the fetal abdomen for transfusion. The physician is responsible for providing a comprehensive written report detailing the imaging aspects of the procedure, which is crucial for medical records and further patient management.

1. Indications

Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis is indicated for several specific conditions and circumstances that necessitate intervention to ensure fetal well-being. The following are the primary indications for performing this procedure:

Fetal Anemia - This condition may arise due to Rh incompatibility, where the mother's immune system destroys the fetal red blood cells, necessitating a transfusion to restore adequate blood levels.
Neonatal Alloimmune Thrombocytopenia - This condition occurs when maternal antibodies target fetal platelets, leading to a significant reduction in platelet counts, which can result in bleeding complications.
Fetal Blood Sampling - Cordocentesis is performed to obtain a fetal blood sample for the diagnosis of various fetal anomalies, infections, or conditions such as thrombocytopenia and anemia.
Isoimmunization - This refers to the immune response triggered by maternal antibodies against fetal blood group antigens, which can lead to serious complications if not monitored and managed appropriately.

2. Procedure

The procedure for ultrasonic guidance during intrauterine fetal transfusion or cordocentesis involves several critical steps to ensure the safety and effectiveness of the intervention. The following outlines the procedural steps:

Step 1: Initial Ultrasound Assessment - Prior to the procedure, an abdominal ultrasound is conducted to evaluate the position of the fetus, locate the placenta, and identify the umbilical vein. This assessment is crucial for planning the approach to the transfusion or cordocentesis.
Step 2: Evaluation of Amniotic Fluid - The level of amniotic fluid is assessed during the initial ultrasound, as it provides important information regarding fetal health and the environment in which the fetus is developing.
Step 3: Needle Insertion - Under continuous ultrasound guidance, the physician carefully inserts a needle into the umbilical vein at the placental insertion site for cordocentesis. Alternatively, for transfusion, the needle may be inserted directly into the fetal abdomen.
Step 4: Monitoring and Procedure Execution - Throughout the procedure, ultrasound imaging is continuously utilized to monitor the proper placement of the needle and to guide the physician in administering the transfusion or obtaining the blood sample. This real-time imaging is essential for minimizing risks and ensuring accurate intervention.
Step 5: Documentation - After the procedure, the physician is responsible for providing a written report that details the imaging component of the procedure, including any findings and the specifics of the intervention performed.

3. Post-Procedure

Following the completion of the intrauterine fetal transfusion or cordocentesis, appropriate post-procedure care is essential to monitor the health and stability of both the mother and the fetus. Patients may be observed for any immediate complications, such as bleeding or signs of infection. Additionally, follow-up ultrasounds may be scheduled to assess fetal well-being and the effectiveness of the transfusion or the results of the cordocentesis. The physician will provide specific instructions regarding activity levels and any signs or symptoms that should prompt immediate medical attention. Continuous monitoring and follow-up care are critical to ensure the ongoing health of the fetus and to address any potential complications that may arise after the procedure.

Short Descr	ECHO GUIDE FOR TRANSFUSION
Medium Descr	US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I
Long Descr	Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No 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)	0 - Payment restriction for assistants at surgery applies 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	Items and Services Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
Type of Service (TOS)	6 - Therapeutic Radiology
Berenson-Eggers TOS (BETOS)	I3B - Echography/ultrasonography - abdomen/pelvis
MUE	3
CCS Clinical Classification	197 - Other diagnostic ultrasound

59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GC	This service has been performed in part by a resident under the direction of a teaching physician
RT	Right side (used to identify procedures performed on the right side of the body)