HIT CPT Surgery Reproductive

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Contents

CPT Reproductive System

(Buck)

  • 55920 Reproductive System Procedures (Surgery)
  • 55970-55980 Intersex Surgery (Surgery)
  • 56405-58999 Female Genital System (Surgery)
  • 59000-59899 Maternity Care and Delivery (Surgery)


Reproductive System Procedures (55920)

  • Reports placement of catheters/needles into pelvic organs/genitalia for subsequent interstitial radioelement application



Intersex Surgery (55970, 55980)

TOP

  • There are only 2 codes within subsection
  • Male to female
  • Female to male
  • Complicated procedures completed over extended period of time
  • Performed by multiple physicians with extensive specialized training

Female Genital System (56405-58999)

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  • Anatomic division: From vulva to ovaries
  • Many bundled services
  • The Female Genital System subsection is divided according to anatomical site
  • Sites are further subdivided according to type of procedure
  • In addition, codes for in vitro fertilization are appended to this section
  • Although this subsection includes a wide variety of codes for minor procedures,
    codes for these minor procedures are often bundled into the major procedures.
  • What is important to determine when bundled services are coded?
    (Which procedures and services are included in the bundle, to avoid coding problems that stem from unbundling)


Format

  • Vulva, Perineum, and Introitus
  • Vagina
  • Cervix Uteri
  • Corpus Uteri
  • Oviduct/Ovary
  • Ovary
  • In Vitro Fertilization
  • How are the subheadings categorized in this section of the CPT?
    (The first six categories represent anatomical regions within the Female Genital System.
    In Vitro Fertilization reflects a specific procedure and is appended to the end of this section.)


Vulva, Perineum, and Introitus (56405-56821)

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  • Para-Urethral ducts
  • External female genitalia
  • Introitus (opening or entrance to vagina)
  • Perineum (area between vulva and anus)
  • Vulva includes:
    • Mons pubis
    • Labia majora
    • Labia minora
    • Bulb of vestibule
    • Vaginal orifice or vestibule of the vagina
    • Greater(Bartholin’s gland)
    • Lesser vestibule glands
    • Clitoris
    • Vaginal opening
  • Skene’s glands coded with Urinary System, Incision or Excision codes
    • Group of small mucous glands, lower end of urethra
      • Paraurethral duct
  • Categories
    • Incision
    • Destruction
    • Excision
    • Repair
    • Endoscopy
  • Why isn’t incision and drainage of Skene’s glands coded in the Vulva, Perineum, and Introitus subheading?
    (Skene’s glands is part of the Urinary System, not the Female Genital System.)
  • Incision (56405-56442)
    • I&D of abscess: Vulva, perineal area, or Bartholin’s gland
    • Marsupialization:
      • Open pouch from an internal abscess
      • Cyst incised
      • Drained
      • Edges sutured to sides to keep cyst open
    • Codes within the Vulva, Perineum, and Introitus subheading are divided by type of procedure and anatomical region.
    • Which anatomical areas are included under the Vulva heading? (Mons pubis, labia majora, labia minora, bulb of vestibule, vaginal orifice or vestibule of the vagina, and Bartholin’s gland and lesser vestibule glands)
    • How are procedures divided in this subheading? (According to anatomical region and type of procedure)
  • Destruction (56501, 56515)
    • Lesions destroyed by variety of methods
      • Destruction = Eradication not excision
        • Excision is removal
    • Divided by Simple or Extensive destruction
      • Complexity based on physician’s judgment
      • Extensive would imply greater physician work, degree of difficulty, or number of lesions destroyed
      • Stated in record
    • Global period of 10 days on Medicare Fee Schedule (56501, 56515)
    • If the patient returns in 2 days for a re-check, it is included in payment for original procedure
    • Destruction: No pathology report
    • The Destruction category contains codes for the destruction of lesions of the vulva, perineum, and introitus.
      Destruction can be accomplished through cryosurgery, electrosurgery, or chemical destruction methods.
    • What is the difference between destruction and excision?
      (Destruction: obliteration or eradication of a lesion; Excision: removal of a lesion)
    • Simple and complex procedures are coded separately.
      Assessment of complexity is based on the physician’s judgment as documented in the medical record.
    • Why is no pathology report generated when a lesion is treated by destruction?
      (Nothing is left of the lesion for analysis when destruction is used.)
  • Excision (56605-56740)
    • Vulvectomy
      • Extent
      • Size
    • Biopsy includes:
      • Local anesthetic
      • Biopsy
      • Simple closure
    • Code based on number of lesions
    • Place number of lesions on CMS-1500 in 24G
    • Separate procedures (56605, 56606)
      • If another service code from female genital subsection performed at same session,
        “separate procedure” codes would not be billed separately
    • Add-on (+) code and describes each separate additional lesion biopsied from **:vulva/perineum (56606)
      • Code cannot stand alone, must be billed (56605)
    • Vulvectomy (Surgical removal of portion of vulva) (56620-56640)
    • Based on extent and size of area removed
    • Extent is:
      • Simple: Skin and superficial subcutaneous tissues
      • Radical: Skin and deep subcutaneous tissues
    • Size:
      • Partial: <80% vulvar area
      • Complete: >80% vulvar area
    • Extent and size, on operative report
    • Some vulvectomy codes include Lymphadenectomy (56631-56632, 56634-56640)
    • Lymphadenectomy (Excision of lymph node(s))
    • Unilateral procedure and has no code to describe bilateral (56640)
      • Bilateral (56640-50)
    • Biopsy codes
      • First lesion (56605)
      • Second and subsequent lesions (56606)
      • Number of units (lesions biopsied) should be indicated in
        box 24G, of the CMS-1500 form
      • Biopsy of three lesions of the vulva (56605, 56606 x 2)
    • Why is it important to indicate the number of units for the biopsy procedure?
      (This will be used to determine reimbursement levels.)
    • Vulvectomy is typically used to treat malignant or premalignant lesions.
      The vulvectomy codes (56620-56640) are divided according to extent of the procedure
      (simple; radical) and whether it is partial or complete.
    • Why are vulvectomy codes divided by extent and size of the area removed?
      (These divisions are important in determining the resources required to deliver the service,
      including the time required to complete the excision and how the repair will be done.)
    • How is the extent of a vulvectomy defined?
      (Extent may be simple, with only skin and superficial subcutaneous tissue involved,
      or radical, with skin and deep subcutaneous tissue involvement.)
    • Radical removal is typically done to treat a malignancy and may include the
      removal of deep lymph nodes, saphenous veins, ligaments, or large amounts of tissue
      from the lower abdomen or even from the thigh.
    • Separate codes are provided for each pairing of extent and size.
    • Note that usual closure is bundled into the procedure,
      but if plastic repair with use of a skin graft is required, it must be coded separately
    • Where are extent and size of the procedure documented? (In the operative report)
  • Repair (56800-56810)
    • Introitus
    • Clitoroplasty
    • Perineoplasty
    • Many plastic repairs
    • Read notes following category
      • If repair procedure for wound of genitalia, use Integumentary System code
    • Endoscopy (56820, 56821)
      • By means of colposcopy, with or without biopsy
    • Procedure codes in the repair category include plastic repair of
      • Introitus
      • Clitoroplasty
      • Perineoplasty
    • When should Integumentary codes be used?
      (When the plastic repair is done as a result of a wound to the genitalia.
      This information is noted at the end of the Repair category code listing.)
    • Endoscopy of the vulva is divided by with or without biopsy


Vagina (57000-57426)

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  • Canal from external female genitalia to uterus
  • Cervix uteri (rounded, cone-shaped neck of uterus, part protruding into vagina)
  • Corpus uteri (uterus)
  • Cystocele (herniation of bladder into vagina)
  • Rectocele (herniation of rectal wall through posterior wall of vagina)
  • Codes divided based on service
  • Two often confused procedures are coded within this subheading:
    • Colpotomy (cutting into the vagina to gain access to the pelvic cavity) (57000-57010)
    • Colpocentesis (incision of the vagina to gain access to the peritoneal
      cul-de-sac—the area between the uterus and the rectum—to explore it or to drain an abscess)
    • If the colpocentesis is part of a more major procedure, it is NOT coded separately
  • Colpotomy
  • Colpocentesis
  • Incision (57000-57023)
    • Colpocentesis
  • Destruction (57061-57065)
  • Excision (57100-57135)
    • Partial or Total
  • Introduction (57150-57180)
    • Includes vaginal irrigation, insertion of devices, diaphragm, cervical caps, pessary
    • Report device inserted separately
      • 99070 or HCPCS, such as A4261 (cervical cap)
    • Coverage for supplies will vary based on payer
    • Medicare bundles 99070 into procedure code and A4261 is non-covered
    • 10-day global period (57180)
    • The Introduction category of the Vagina subheading includes codes for
      Main types of Procedures: (x3)
      • Vaginal Irrigation
      • Insertion of a support device (pessary), diaphragm, or cervical cap to prevent pregnancy; these codes include not only insertion of devices, but also removal of them.
      • Packing of the vagina ( vaginal hemorrhage)
    • How are the codes in this category organized?
      (According to the type of procedure performed)
    • Fitting and supply of a diaphragm with instructions for use (57170, 99070)
  • Repair (57200-57335)
    • Colporrhaphy
    • Colpopexy
    • Approach
    • For Nonobstetric repairs
      • Obstetric repairs, use Maternity Care and Delivery codes
    • Global period usually 90 days
    • Review the operative report for specific details relevant to accurate code assignment
    • The Repair category of the Vagina subheading includes an extensive list of procedures,
      all of which are nonobstetrical in nature.
    • Where would codes for obstetrical repair procedures be located?
      (In the Maternity Care and Delivery subsection)
    • Plastic Repair of Urethrocele (57230)
  • Manipulation (57400-57415)
    • Dilation (Speculum inserted into vagina and enlarged using dilator)
    • Procedures done under general anesthesia or spinal anesthesia
    • Foreign body removed from vagina without anesthesia, assign E/M code
    • Not appropriate to bill pelvic exam under anesthesia when other related procedures performed at same session
      • Example, D&C
    • Procedures coded in the Manipulation Category
      • Dilation (stretching)
      • Pelvic Examination
      • Removal of Foreign Material
    • All procedures are performed with the patient under general anesthesia.
      If general anesthesia is not required, these codes are not used.
      Instead, the procedure is coded from the Evaluation and Management Service section
    • General anesthesia
  • Endoscopy (57420-57426)
    • Colposcopy codes based on purpose
      • e.g., biopsy, diagnostic, LEEP (loop electrocautery excision procedure)
      • LEEP uses heated wire to excise, AKA: diathermy
      • Includes:
        • Laparoscopic approach for repairing paravaginal defects
    • Endoscopic procedures for the Vagina subheading are identified as
      • Colposcopic procedures
    • These procedures are often bundled into other, more major procedures, in which case they are not coded separately.
    • When they are the only procedures performed or are unrelated to other procedures performed, they are coded here.
    • Which procedures do they include?
      • Biopsy of the cervix or the endocervical canal and a LEEP procedure [cervical loop diathermy], in which a heated wire is used to remove cervical tissue.
      • Note that this is a less expensive and less risky procedure than a more conventional biopsy approach.)
    • Colposcopy
      • Colposcopy enables physician to view an endocervical polyp
      • How does use of a colposcope aid the physician?
        (The colposcope enables the physician to directly view changes in the vagina and cervix.)


Cervix Uteri (57452-57800)

TOP

  • Dilation (expansion)
  • Cervix uteri, narrow, lower end of uterus; services include
    • Endoscopy
    • Excision
    • Manipulation
    • Repair
  • Codes for endoscopy, excision, repair, and manipulation are included under this subheading.
  • Where is the cervix uteri located?
    (It is the rounded, cone-shaped neck of the uterus that is located between the isthmus and the ostium uteri.)
  • LEEP
    • LEEP, LETZ, or cervical loop diathermy relatively new office procedure
    • The LEEP/LETZ/cervical loop diathermy procedure is a relatively new office procedure:
    • It is used to cauterize the site at the end of the procedure.
    • It is often used as a follow-up to an abnormal Pap smear or abnormal examination.
    • What is the purpose of the LEEP Procedure?
      (The LEEP procedure is used to obtain a tissue sample for pathological analysis.
      It is a less invasive and cheaper alternative to a biopsy.)
  • Endoscopy (57452-57461)
  • Excision (57500-57558)
    • Conization
    • LEEP
    • Cervical Biopsy
    • Cervical Conization
    • Conization codes
      • Conization (Removal of cone of tissue from cervix)
    • LEEP technology can be used for conizations
    • Excision codes in cervix uteri describe technique and approach used, as well as component procedures included in some code descriptions
  • Excision codes of the cervix uteri are used when these procedures are performed as separate procedures and are not bundled into a more major procedure (e.g., an excision for biopsy is often incidental to a more major surgical procedure such as a hysterectomy, in which case the biopsy is not coded separately).
    • How is conization performed? (Conization: cone-shaped section of tissue is removed from the cervix for biopsy or for treatment of a lesion. LEEP technology and lasers are both used for this procedure. Codes are divided on the basis of the method used to obtain the tissue.)
  • Repair (5770-57720)
    • Nonobstructive cerclage
    • Trachelorrhaphy
  • Manipulation (57800)
    • Dilation of cervical canal, instrument (57800)


Corpus Uteri (58100-58579)

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  • Many complex procedures
  • Often very similar wording in code descriptions
  • Requires careful reading
  • Corpus uteri: Located above the isthmus and below the opening for the fallopian tubes.
  • The subheading contains categories of procedures that involve excision, introduction, repair, and laparoscopy/hysteroscopy procedures.
  • Why do the codes in the Corpus Uteri subheading require careful review when they are used? (The procedures in this section are complex, and multiple variations of some of these procedures are included here. Failure to read carefully could easily result in selection of the wrong code.)
  • Excision (58100-58294)
    • Curettage (scraping of cavity using spoon shaped instrument)
    • Endometrial sampling
    • Dilation and Curettage (D&C, 58120)
    • Hysterectomy
      • Approach
        • Abdominal
        • Vaginal
      • Extent
    • Dilation and curettage (D&C) of Uterus (58120)
      • After dilation, curette scrapes uterus
    • Do not report postpartum hemorrhage service with 58120
      • Maternity and Delivery code (59160)
    • Many hysterectomy codes
      • Based on
        • Approach (vaginal, abdominal) and
        • Extent (uterus, fallopian tubes, etc.)
    • Often secondary procedures performed with hysterectomy
    • Do not code secondary related minor procedures separately
    • Describe how and why a D&C procedure is performed.
    • D&C in this subheading is for nonobstetrical patients only. If performed in conjunction with Maternity Care and Delivery, a code from that section would be used.
    • Many third-party payers will not reimburse for this procedure if it is performed with any other pelvic surgery, as it is considered to be part of the other procedure. It is not listed as a separate procedure code in the CPT.
    • Is a D&C ever coded separately?
      (Yes, when it is the only procedure used, or when third-party payer guidelines permit separate coding)
    • Hysterectomy codes represent most of the codes in this heading
    • Hysterectomy always involves removal of the uterus, but there are many variations.
    • Hysterectomy codes are first divided on approach, which may be abdominal or vaginal, and then by extent, i.e., whether additional structures were removed or procedures performed.
    • Why is it important to carefully review the hysterectomy codes when coding this procedure? (If code descriptions are not reviewed carefully, the wrong code may be selected, resulting in overbilling or underbilling. In addition, inadvertent unbundling of procedures may occur.)
    • Secondary procedures are often performed by means of a hysterectomy. These may include biopsy, removal of the fallopian tubes or ovaries, etc.
    • Why should you avoid coding related minor secondary procedures separately?
      (Because they are bundled into the codes for the hysterectomy)
  • Introduction (58300-58356)
    • Intrauterine Device (IUD) (99070)
    • Artificial Insemination
      • Intrauterine Insemination (IUI)
    • In vitro Fertilization
    • Hysterosalpingography
    • Chromotubation
    • Common procedures
      • e.g., Insertion of an IUD
    • Report supply of device separately
    • Specialized services
      • e.g., artificial insemination procedures
    • Used to report physician component of service
    • Component coding
      • Necessary with catheter procedures for hysterosonography
      • Notes following codes indicate radiology guidance component codes
    • Codes found in the Introduction category include the following:
    • Codes for insertion and removal of an IUD
    • Codes for artificial insemination
    • How is the IUD itself coded? (The IUD is coded with use of 99070 from the Medicine section, the standard code for non-included materials and supplies used by the physician during a procedure.)
    • Hysterosalpingography and Hysterosonography are two procedures coded here that rely on radiologic support.
    • Hysterosalpingography: saline or contrast material is introduced through the cervix, uterus, and fallopian tubes so that these can be examined by the physician for any blockage or abnormalities.
    • Hysterosonography: uses ultrasound to complete the same procedure.
    • These procedures are subject to component coding. What does this mean?
      (Technical component: coded from the Radiology section. Professional component:
      coded here by the physician performing the procedure.)
  • Laparoscopy/Hysteroscopy (58541-58579)
    • All include diagnostic procedure
    • Laparoscopic approach for:
      • Removal of myomas or uterus
      • Codes divided by tissue and weight
    • Artificial insemination, including the preparation of sperm for use in the procedure, is coded here.
    • Sperm is injected into the cervix, and a cervical cap may then be inserted to hold the sperm in place.
    • How are these codes used? (They are used to report the physician component of the service.)
    • Laparoscopy
      • Through abdomen
      • In all, two to three small incisions are made in the abdomen.
        Lights, cameras, and instruments are then passed through these openings.
      • Why would laparoscopic procedures be preferred?
        (They are less invasive than open surgical procedures, recovery times are shorter;
        and risks to the patient are lowered.)
    • Hysteroscopy through uterus
      Surgical laparoscopy with vaginal hysterectomy (58550)
    • With this procedure, scopes are placed through the abdomen and through the vagina to provide visualization during a vaginal hysterectomy.
    • Codes in this category are divided on the basis of other procedures that may have been performed along with the hysteroscopy.
    • With this procedure, would use of the laparoscope be coded separately? (No, it would be bundled into the code for the hysteroscopy.)
    • There are codes for supracervical hysterectomies performed by surgical laparoscopy which are further divided by weight of the uterus and whether removal of tubes and ovaries was also performed.

Oviduct/Ovary (58600-58770)

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  • Salpingo- (tube)
  • Oviduct (fallopian tube)
  • Incision category contains tubal ligations
    • When during same hospitalization as delivery, ligation is coded separately
  • Watch “separate procedure” codes
    • If another related procedure is performed at same session “separate procedures” are not billed separately
  • Oviduct/Ovary subsection: Procedures performed on the ovaries and fallopian tubes, including incision, laparoscopy, excision, and repair
  • Circumstances affect coding. Use separate codes for unilateral and bilateral procedures and to reflect timing of the procedure.
  • When ligation is performed during the same hospitalization as delivery, is it included in the pregnancy bundle? (No, it is coded separately because it falls outside of standard maternity services.)
  • Incision
    • Ligation
      • Tying
      • Removing
      • Blocking
    • Approach
      • Abdominal
      • Vaginal
    • Lysis (loosening) of adhesions
  • Laparoscopy (58660-58679)
    • Fulguration of oviducts (Fulguration of obstructed oviducts)
    • Based on purpose of procedure
      • e.g., Lysis, lesion removal
    • Caution: If only diagnostic laparoscopy:
      • Do not use Female Genital System codes
      • Digestive System (49320)
    • Codes from the Laparoscopy category used for procedures in the Oviduct/Ovary subheading are always surgical procedures that include a diagnostic component.
    • If the procedure begins as a diagnostic exploration and ends without definitive action, use codes from the Digestive System because the location of the procedure will determine coding, and the location will be the abdomen.
    • If laparoscopy results in performance of a procedure on the ovaries or fallopian tubes, it will be coded in terms of the procedure performed—for example, lysis of adhesions, oophorectomy, and lesion excision.
    • How are laparoscopy procedures generally coded?
      (According to the full extent of the procedure)
    • Laparoscopy with fulguration of oviducts (58670)
    • Unilateral Ovarian Cystectomy, Laparoscopic
      58661
  • Excision (58700-58720)
  • Repair (58740-58770)
    • Salpingolysis
    • Ovariolysis

Ovary (58800-58960)

TOP

  • Oophor- (ovary)
  • Categories (x2)
    1. Incision
    2. Excision
  • Categories of codes in the Ovary subheading: (x2)
    • Incision: For the drainage of cysts.
    • Excision: To report ovarian biopsy, cystectomy, and oophorectomy.
  • How are these procedures divided? (Incision codes are divided on the basis of approach; excision codes are based on type of procedure.)
  • Incision (58800-58825)
    • Primarily for drainage of cysts and abscesses
    • Divided on surgical approach
    • Transposition of ovary (58825)
  • Excision (58900-58960)
    • Biopsy
    • Wedge resection
    • Oophorectomy


In Vitro Fertilization (58970-58976)

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  • Fertilize egg outside the body
  • Aspiration of the Ova with Ultrasound Guidance (76948) (Radiology, Ultrasound Guidance)
  • Specialized codes used by physicians trained in fertilization procedures
    • Codes divided by type of procedure and method used
  • Specialized codes provide for in vitro fertilization, a procedure in which eggs are fertilized outside the body and prepared for implantation at a later time. Note that third-party payers often deny claims for fertility services.
  • Divided By
    • Type of procedure
    • Method used

Maternity Care and Delivery (59000-59899)

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  • Antepartum (before childbirth)
  • Postpartum (after childbirth)
  • Abortion (termination of pregnancy)
  • Amniocentesis (percutaneous aspiration of amniotic fluid)
  • Delivery (childbirth)
  • Ectopic (pregnancy outside of uterus)
  • Version (turning of fetus from presentation other than cephalic (head down) to cephalic)
  • Cordocentesis (percutaneous umbilical blood sampling, fetal blood sample)
  • Chorionic Villus Sampling (CVS) (biopsy of outermost part of placenta)
  • Hysterotomy (incision into uterus)
  • Hysterectomy (removal of uterus)
  • Hysterorrhaphy (suturing of uterus)
  • Salpingectomy (removal of uterine tube, removal of fallopian tube)
  • Oophorectomy (removal of ovary. removal of ovaries)
  • Tocolysis (repression of uterine contractions)
  • Divided by Service
    • Antepartum Services
      • Amniocentesis
      • Fetal Non-stress test
    • Type of Delivery
      • Vaginal Delivery
      • C Section
      • Delivery after C Section
    • Abortion
  • Divided according to type of procedure
  • In general, codes progress from those used in the antepartum period through delivery, on to the procedures of the postpartum period.
  • Abortion codes are found at the end of the subsection.
  • Main categories of the Maternity Care and Delivery
    • Antepartum Services
    • Vaginal Delivery
    • Cesarean Delivery
    • Abortion
  • Many notes are “must reading”
  • There are codes describing a global service or portions only (e.g., delivery only)
  • Many notes and detailed guidelines for coding services from this section are provided.
  • Why is it important to become familiar with the guidelines and notes provided for services coded from this section?
    (To ensure accuracy in coding. Because many bundled procedures are included in this section, it is doubly important
    for the coder to read this information here.)


Format

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  • Trimester
  • Abortion by method


Maternity and Delivery (59000-59899)

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  • Fetus Gestation: 266 days (40 weeks)
  • Last Menstrual Period (LMP)
  • Estimated Date of Delivery (EDD)
    • 280 days from last menstrual period (LMP)
    • Conception is assumed to occur 14 days after the LMP)
  • Trimesters
    • First LMP to week 12
    • Second Weeks 13-27
    • Third Weeks 28-EDD
  • Antepartum care
  • Postpartum care
  • Global Package and Delivery
    • Uncomplicated maternity case includes:
      • Antepartum care (before birth)
      • Delivery
      • Postpartum care (after birth)
    • What period is covered by the obstetrical bundle?
      (All services delivered from the LMP until the end of the postpartum period,
      approximately 6 weeks after delivery)
    • What codes describe the global obstetrical package on the basis of delivery?
      • Vaginal delivery (59400)
      • Cesarean delivery (59510)
      • Vaginal delivery after a previous cesarean delivery (VBAC) (59610)
      • Cesarean delivery following an
        attempted vaginal delivery after previous cesarean delivery (59618)
    • If the physician provides only a portion of the care, one should use codes that describe care as delivery only or postpartum only,
      according to the delivery method used.

Routine Obstetric Care

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  • Vaginal delivery (59400)
  • Cesarean section (59510)
  • Vaginal delivery after previous c-section (59610)
  • Cesarean following attempted vaginal, after previous c-section (59618)
  • Vaginal birth after cesarean (VBAC)
  • Vaginal birth after cesarean section (VBACS)
  • Portion of global routine obstetric care
  • Twins
    • Modifier -22
    • Modifier -51
  • Routine Global Obstetric Care
    • 59400, Vaginal delivery
    • 59510, Cesarean delivery
    • 59610, Vaginal delivery after previous cesarean delivery (VBAC)
    • 59618, Cesarean delivery following attempted vaginal delivery after previous cesarean delivery
    • Which factors can be used to distinguish codes used for routine obstetrical care? (Mode of delivery is the sole factor that distinguishes these codes.)
  • Physician Provides Only Portion of Global Care
    • Vaginal delivery only (59409)
    • Cesarean delivery only (59514)
    • Vaginal delivery only, after previous cesarean delivery (59612)
    • Cesarean delivery only, following attempted vaginal delivery,
      after previous cesarean delivery (59620)
    • In some instances, a physician may provide only a portion of the global routine care. In this case, global delivery codes are not used.
    • Which codes are used when a physician provides only a portion of the global routine care (i.e., the delivery)? **:(Separate codes that reflect delivery only are used in this case.)
  • Delivery of Twins
    • Payers differ on reporting format
    • Modifier -22 (Unusual Procedural Services)
    • Modifier -51 (Multiple Procedures)
    • The standard obstetrical package includes a single live birth.
      For multiple births and/or unusual procedures, modifiers are required.
    • Which modifier is used to report unusual procedural services?
      (Modifier -22 is used to report these services.)


Antepartum Services

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  • Initial and subsequent H&P
  • Blood pressure
  • Weight
  • Routine urinalysis
  • Fetal heart tones
  • Monthly visits to 28 weeks
  • Twice-a-month visits weeks 29 to 36
  • Weekly visits from week 37 to delivery
  • Code services not related to antepartum care separately
    • e.g., Pregnant female with complaint of suspicious mole on left shoulder
    • Visits to OB/GYN physician, who is providing antepartum care
    • Service regarding mole not antepartum care
  • Which of the procedures provided for an uncomplicated pregnancy during the antepartum period may be coded separately?
    (Only those services that are not considered part of the standard obstetrical care bundle)
  • How do you determine whether services can be coded, in addition to the pregnancy bundle? (The services must be over and above those ordinarily provided for an uncomplicated pregnancy. These would include services for unrelated conditions such as a suspicious mole on a patient’s shoulder.)
  • Delivery includes
    • Episiotomies and Use of Forceps
      • Included in delivery
      • Not reported separately
      • Why are episiotomies and use of forceps included in standard obstetrical care?
        (Both are services that are frequently required in normal delivery.)
    • Admission to hospital with admitting H&P
    • Management of uncomplicated labor
    • Vaginal or Cesarean section delivery
      • Complications coded separately
      • Placement of internal fetal and/or uterine monitors
      • Catheterization or catheter insertion
      • Delivery of placenta
      • Induction of labor
      • Artificial rupture of membranes
      • Injection of local anesthetic
    • Reported separately:
      • Fetal scalp blood sampling
      • External cephalic version
      • Administration of epidural
    • How are additional services required for a complicated delivery reported?
      (Services for a complicated delivery are reported separately.)
  • Postpartum Care Includes
    • Hospital & office visits following delivery
      • Exploration of uterus
      • Episiotomy and repair
      • Repair of cervical, vaginal, or perineal lacerations
      • Placement of a hemostatic pack or agent
    • Normal follow-up care for 6 weeks after delivery:
      • e.g., Hospital visits, office visits
      • Not reported separately
    • How is standard postpartum care coded?
      (It is included in the obstetric bundle and is not coded separately.)
  • Antepartum and Fetal Invasive Services (59000-59076)
    • Amniocentesis (Insertion of needle into pregnant uterus, withdraws fluid) (59000)
      • Ultrasound guidance with this service (76946)
    • Component coding often part of services in subheading
    • Amniocentesis is an example of a service provided during the antepartum period that falls outside the range of
      standard obstetrical care and is therefore coded separately.
    • When is component coding required? (When the procedure and the radiologic services
      that support it are provided by different physicians)
    • Fetal services: Include stress tests, blood sampling, monitoring, and therapeutic services
    • OB Ultrasound codes (76801-76828)
    • Additional procedures that fall outside of the range of standard care include fetal services such as stress tests, monitoring, and therapeutic services.
    • Why are these services coded separately? (Because they fall outside of the range of services included in the obstetrical bundle)
  • Amniocentesis (59000, 59001)
  • Cordocentesis (59012)
  • Excision (59100-59160)
    • Abdominal Hysterectomy (59100)
    • Ectopic Pregnancy
    • Postpartum Curettage
    • Postpartum Curettage: Removes remaining pieces of placenta or clotted blood (59160)
    • Nonobstetric Curettage: (58120) (Corpus Uteri, Excision)
    • Excision codes are used for postpartum curettage, performed within the first 6 weeks after delivery to remove
      remaining pieces of placenta or clotted blood.
      An abdominal hysterotomy, performed to remove a hydatidiform or embryo, would also fall into this category.
    • How is a nonobstetrical curettage coded? (It is coded to the Female Genital System, under Corpus Uteri/Excision.)
  • Introduction (59200)
    • Cervical Dilator
    • Insertion of cervical dilator:
      Used to prepare cervix for an abortive procedure or delivery
    • Cervical ripening agents may be introduced to prepare cervix
      • Softens and opens cervix
    • Induction may be elective or required, according to the medical risk factor assigned to the mother or fetus.
    • Physicians use a scoring system to measure the stage of cervical ripening and may introduce a preparation such as Prepidil gel intracervically through a catheter to speed the process of cervical ripening.
    • Why is dilation required? (Dilation in this case involves stretching of the opening of the cervix. Without dilation, delivery would not be possible.)
    • Cervical Ripening
      • Bishop Scoring System used to assess cervical ripening
    • Score is based on dilation, effacement, station, consistency, and cervical position
  • Repair (59300-59350)
    • Only for repairs during pregnancy
    • Not for repairs done during delivery or after pregnancy
    • Which class of repairs is covered in the Repair subheading? (Only repairs performed during pregnancy and before delivery; those done during delivery or during the postpartum period are not reflected here.)
    • Hysterorrhaphy of a ruptured, pregnant uterus (59350)
  • Vaginal Delivery, Antepartum and Postpartum Care (59400-59430)
  • Cesarean Delivery (59510-59515)
    • 59515 (Cesarean Delivery, Postpartum Care),
      58611 (Tubal Ligation, with Cesarean Delivery)
      Note: 58611 is "not a separate procedure,"
      which means it is reported in addition to major procedure, in this case a cesarean delivery
  • Delivery After Previous Cesarean Delivery (59610-59622)
  • Abortion Services (59812-59857)
    • Spontaneous abortion (Miscarriage)
    • Incomplete abortion
    • Missed Abortion
    • Septic Abortion
    • Induced Abortion
    • Spontaneous: Happens naturally
    • Incomplete: Requires medical intervention
    • Missed: Fetus dies naturally during first or second trimester
    • Septic: Missed abortion with infection
    • Medical intervention
    • Dilation and curettage or evacuation (suction removal)
    • Intra-amniotic injections (saline or urea)
    • Vaginal suppositories (prostaglandin)
    • When are abortion services required? (Whenever a fetus is expelled from the uterus [completely or partially] either naturally or through medical intervention)
    • Medical intervention may be used to induce abortion. What is the basis for coding in this case?
      (Coding is based on the procedure used.)
    • If intra-amniotic injection or vaginal suppositories fail to induce an abortion, then a hysterotomy may be required.


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