Summary & Overview
HCPCS S2405: In Utero Repair of Sacrococcygeal Teratoma
HCPCS Level II code S2405 represents the in utero repair of a sacrococcygeal teratoma, a rare fetal surgical procedure performed to address a tumor at the base of the fetal spine. The code denotes a highly specialized, resource-intensive operative service with implications for maternal-fetal medicine, pediatric surgery, and tertiary care facilities. Nationally, this service is clinically significant due to its complexity, the need for multidisciplinary teams, and potential impacts on neonatal outcomes and perinatal resource utilization.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, a summary of which major payers include coverage or policy considerations where available, and a clear statement of what data elements were and were not provided. The publication outlines expected benchmarks and policy-relevant points for this type of fetal intervention, including coding purpose, typical site of service, and payer landscape. It is intended for coding professionals, clinicians in maternal-fetal medicine and pediatric surgery, and payer policy analysts seeking a national-level primer on S2405.
Billing Code Overview
HCPCS Level II code S2405 describes repair of sacrococcygeal teratoma in the fetus, procedure performed in utero. This is an intrauterine fetal surgical procedure aimed at removing or repairing a sacrococcygeal teratoma while the fetus remains in utero.
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Service type: Fetal surgical procedure (in utero repair)
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Typical site of service: Inpatient specialized fetal surgery unit or operating room with maternal-fetal medicine and pediatric surgical capabilities
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Clinical & Coding Specifications
Clinical Context
A pregnant patient in the second or early third trimester presents after detailed fetal imaging identifies a large sacrococcygeal teratoma with rapid growth, hydrops fetalis, or mass effect threatening fetal viability. The maternal-fetal medicine team coordinates a multidisciplinary workflow including fetal surgery, maternal anesthesia, neonatology, pediatric surgery, and transfusion services. Preoperative evaluation includes serial ultrasound and fetal MRI to assess tumor size, vascularity, and placental relationship, fetal echocardiography to evaluate for high-output cardiac failure, and maternal assessment for operative risk. Informed consent addresses fetal intervention risks, potential preterm delivery, and maternal complications.
A typical in utero repair is scheduled in an operating room or dedicated fetal surgery suite with capabilities for open fetal surgery or fetoscopic techniques depending on tumor anatomy. Maternal general anesthesia with fetal monitoring is used; a hysterotomy or fetoscopic ports are placed, the tumor resected or debulked, and the uterine wall closed. Postoperative care includes maternal monitoring for hemorrhage and infection, tocolysis as indicated, serial imaging to assess residual tumor and fetal well-being, and planning for delivery and definitive neonatal surgery if needed. Discharge planning involves coordination with pediatric surgery and neonatal intensive care for anticipated postnatal care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier |