1. 1 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CHAPTER 8 FEMALE GENITAL SYSTEM AND MATERNITY CARE AND DELIVERY

2. 2 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Female Genital System Anatomic division: From vulva to ovariesAnatomic division: From vulva to ovaries Many bundled servicesMany bundled services

3. 3 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Female Genital System Subheadings Vulva, Perineum, and IntroitusVulva, Perineum, and Introitus VaginaVagina Cervix UteriCervix Uteri Corpus UteriCorpus Uteri Oviduct/OvaryOviduct/Ovary OvaryOvary In Vitro FertilizationIn Vitro Fertilization

4. 4 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Vulva, Perineum, and Introitus Skene’s glands coded with Urinary System, Incision or Excision codesSkene’s glands coded with Urinary System, Incision or Excision codes –Group of small mucous glands, lower end of urethra Paraurethral ductParaurethral duct CategoriesCategories –Incision –Destruction –Excision –Repair –Introduction –Manipulation –Endoscopy –In Vitro Fertilization

5. 5 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Incision Category (56405-56442) From Andrews G, editor: Women’s Sexual Health, ed 3, 2005, Elsevier. I&D of abscess: Vulva, perineal area, or Bartholin’s glandI&D of abscess: Vulva, perineal area, or Bartholin’s gland Marsupialization:Marsupialization: –Cyst incised –Drained –Edges sutured to sides to keep cyst open

6. 6 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Destruction (56501, 56515) Lesions destroyed by variety of methodsLesions destroyed by variety of methods –Destruction = Eradication not excision Excision is removalExcision is removal(Cont’d…)

7. 7 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Destruction (56501, 56515) (…Cont’d) Divided by simple or extensive destructionDivided 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 Destruction: No pathology reportDestruction: No pathology report

8. 8 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (56605-56740) Biopsy includes:Biopsy includes: –Local anesthetic –Biopsy –Simple closure Code based on number of lesionsCode based on number of lesions Place number of lesions on CMS-1500 in 24GPlace number of lesions on CMS-1500 in 24G(Cont’d…)

9. 9 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (56605-56740) (…Cont’d) Codes 56605 & 56606 are designated “separate procedures”Codes 56605 & 56606 are designated “separate procedures” –If another service code the female genital subsection performed at same session, “separate procedure” codes would not be billed separately Vulvectomy: Surgical removal of portion of vulva (56620-56640)Vulvectomy: Surgical removal of portion of vulva (56620-56640) Based on extent and size of area removedBased on extent and size of area removed(Cont’d…)

10. 10 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (56605-56740) (…Cont’d) Extent is:Extent is: Simple: Skin and superficial subcutaneous tissuesSimple: Skin and superficial subcutaneous tissues Radical: Skin and deep subcutaneous tissuesRadical: Skin and deep subcutaneous tissues 56501/56515 have a global period of 10 days on Medicare Fee Schedule56501/56515 have a global period of 10 days on Medicare Fee Schedule If the patient returns in 2 days for re-check, it is included in payment for original procedureIf the patient returns in 2 days for re-check, it is included in payment for original procedure(Cont’d…)

11. 11 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (56605-56740) (…Cont’d) Size:Size: –Partial: <80% vulvar area –Complete: >80% vulvar area Extent and size, on operative reportExtent and size, on operative report Some vulvectomy codes include lymphadenectomy (56631-56632, 56634-56640)Some vulvectomy codes include lymphadenectomy (56631-56632, 56634-56640) Code 56640 is unilateral procedure and has no code to describe bilateralCode 56640 is unilateral procedure and has no code to describe bilateral –Bilateral, report 56640-50

12. 12 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Repair (56800-56810) Many plastic repairsMany plastic repairs Read notes following categoryRead notes following category –If repair procedure for wound of genitalia, use Integumentary System code Endoscopy (56820, 56821)Endoscopy (56820, 56821) –By means of colposcopy, with or without biopsy 56606 is add-on (+) code and describes each separate additional lesion biopsied from vulva/perineum56606 is add-on (+) code and describes each separate additional lesion biopsied from vulva/perineum –Code cannot stand alone, must be billed with 56605

13. 13 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Vagina (57000-57425) Codes divided based on service (e.g., incision, excision)Codes divided based on service (e.g., incision, excision)

14. 14 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Introduction (57150-57180) Includes vaginal irrigation, insertion of devices, diaphragm, cervical capsIncludes vaginal irrigation, insertion of devices, diaphragm, cervical caps Report device inserted separatelyReport device inserted separately –99070 or HCPCS, such as A4261 (cervical cap) Coverage for supplies will vary based on payerCoverage for supplies will vary based on payer Medicare bundles 99070 into procedure code and A4261 is non-coveredMedicare bundles 99070 into procedure code and A4261 is non-covered Code 57180 has a 10 Day global periodCode 57180 has a 10 Day global period

15. 15 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Repair (57200-57335) For nonobstetric repairsFor nonobstetric repairs –Obstetric repairs, use Maternity Care and Delivery codes Global period usually 90 daysGlobal period usually 90 days Review the operative report for specific details relevant to accurate code assignmentReview the operative report for specific details relevant to accurate code assignment

16. 16 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Manipulation (57400-57415) Dilation: Speculum inserted into vagina and enlarged using dilatorDilation: Speculum inserted into vagina and enlarged using dilator All procedures are done under general anesthesia or spinal anesthesiaAll procedures are done under general anesthesia or spinal anesthesia If foreign body were removed from vagina without anesthesia, appropriate code assignment would be an E/M codeIf foreign body were removed from vagina without anesthesia, appropriate code assignment would be an E/M code Not appropriate to bill a pelvic exam under anesthesia when other related procedures are performed at same sessionNot appropriate to bill a pelvic exam under anesthesia when other related procedures are performed at same session –Example a D&C

17. 17 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Endoscopy (57420-57425) Colposcopy codes based on purposeColposcopy 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 defectsLaparoscopic approach for repairing paravaginal defects

18. 18 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Colposcopy Figure: 8.2 Colposcopy enables physician to view an endocervical polypColposcopy enables physician to view an endocervical polyp From Baggish MS: Colposcopy of the Cervix, Vagina, and Vulva: A Comprehensive Textbook, Philadelphia, 2003, Mosby.

19. 19 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. LEEP LEEP, LETZ, or cervical loop diathermy relatively new office procedureLEEP, LETZ, or cervical loop diathermy relatively new office procedure Figure: 8.3 From Llewellyn-Jones D: Fundamentals of Obstetrics and Gynaecology, ed 7, 1999, Mosby Ltd.

20. 20 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cervix Uteri Figure: 8.1 Cervix uteri, narrow, lower end of uterus; services include endoscopy, excision, manipulation, repairCervix uteri, narrow, lower end of uterus; services include endoscopy, excision, manipulation, repair

21. 21 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (57500-57558) Conization codesConization codes –Conization: Removal of cone of tissue from cervix LEEP technology can be used for conizationsLEEP 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 descriptionsExcision codes in cervix uteri describe technique and approach used, as well as component procedures included in some code descriptions

22. 22 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Corpus Uteri (58100-58579) Many complex proceduresMany complex procedures –Often very similar wording in code descriptions –Requires careful reading

23. 23 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (58100-58294) Dilation and curettage (D&C, 58120) of uterusDilation and curettage (D&C, 58120) of uterus –After dilation, curette scrapes uterus Do not report postpartum hemorrhage service with 58120Do not report postpartum hemorrhage service with 58120 –Use 59160—Maternity and Delivery code (Cont’d…) From Chabner DE: The Language of Medicine, ed 8, St. Louis, 2007, Saunders.

24. 24 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. (…Cont’d) Many hysterectomy codesMany hysterectomy codes –Based on approach (vaginal, abdominal) and extent (uterus, fallopian tubes, etc.) (Cont’d…) Excision (58100-58294) Total hysterectomy Total hysterectomy Total hysterectomy with bilateral salpingo-oophorectomyTotal hysterectomy with bilateral salpingo-oophorectomy From Chabner DE: The Language of Medicine, ed 8, St. Louis, 2007, Saunders.

25. 25 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (58100-58294) (…Cont’d) Often secondary procedures performed with hysterectomyOften secondary procedures performed with hysterectomy Do not code secondary related minor procedures separatelyDo not code secondary related minor procedures separately

26. 26 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Introduction (58300-58356) From Chabner DE: The Language of Medicine, ed 8, St. Louis, 2007, Saunders. Common proceduresCommon procedures –e.g., Insertion of an IUD Report supply of device separatelyReport supply of device separately Specialized servicesSpecialized services –e.g., artificial insemination procedures Used to report physician component of serviceUsed to report physician component of service(Cont’d…)

27. 27 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Laparoscopy/Hysteroscopy (58541-58579) Laparoscopic approach for:Laparoscopic approach for: –Removal of myomas or uterus –Codes divided by tissue and weight

28. 28 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Introduction (58300-58356) (…Cont’d) Component codingComponent coding –Necessary with catheter procedures for hysterosonography –Notes following codes indicate radiology guidance component codes

29. 29 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Through abdomenThrough abdomen(Cont’d…) Laparoscopy Figure: 8.4

30. 30 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Laparoscopy/Hysteroscopy (58541-58579) (…Cont’d) Figure: 8.5 Hysteroscopy through uterus. Surgical laparoscopy with vaginal hysterectomy, 58550Hysteroscopy through uterus. Surgical laparoscopy with vaginal hysterectomy, 58550

31. 31 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Oviduct/Ovary (58600- 58770) Oviduct: Fallopian tubeOviduct: Fallopian tube Incision category contains tubal ligationsIncision category contains tubal ligations –When during same hospitalization as delivery, ligation is coded separately Watch “separate procedure” codesWatch “separate procedure” codes –If another related procedure is performed at same session “separate procedures” are not billed separately

32. 32 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Laparoscopy (58660-58679) Based on purpose of procedureBased on purpose of procedure –e.g., Lysis, lesion removal Caution: If only diagnostic laparoscopy:Caution: If only diagnostic laparoscopy: –Do not use Female Genital System codes –Use 49320, Digestive System

33. 33 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Ovary Two categories only: Incision and ExcisionTwo categories only: Incision and Excision Incision: Primarily for drainage of cysts and abscessesIncision: Primarily for drainage of cysts and abscesses –Divided on surgical approach Excision: Biopsy, wedge resection, and oophorectomyExcision: Biopsy, wedge resection, and oophorectomy

34. 34 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. In Vitro Fertilization (58970-58976) Specialized codes used by physicians trained in fertilization proceduresSpecialized codes used by physicians trained in fertilization procedures –Codes divided by type of procedure and method used

35. 35 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Maternity Care and Delivery (59000-59899) Divided by service:Divided by service: –Antepartum services AmniocentesisAmniocentesis Fetal non-stress testFetal non-stress test –Type of delivery Vaginal deliveryVaginal delivery C sectionC section Delivery after C sectionDelivery after C section –Abortion

36. 36 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Maternity Care and Delivery Notes Many notes are “must reading”Many notes are “must reading” There are codes describing a global service or portions only (ex., delivery only)There are codes describing a global service or portions only (ex., delivery only)

37. 37 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Gestation Fetal gestation: Approximately 266 days (40 weeks)Fetal gestation: Approximately 266 days (40 weeks) EDD: Estimated Date of DeliveryEDD: Estimated Date of Delivery –280 days from last menstrual period (LMP)

38. 38 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Trimesters First: LMP to Week 12First: LMP to Week 12 Second: Weeks 13-27Second: Weeks 13-27 Third: Week 28-EDDThird: Week 28-EDD

39. 39 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Global Package and Delivery Uncomplicated maternity case includes:Uncomplicated maternity case includes: –Antepartum care (before birth) –Delivery –Postpartum care (after birth)

40. 40 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Antepartum Care Includes Initial and subsequent H&PInitial and subsequent H&P Blood pressureBlood pressure WeightWeight Routine urinalysisRoutine urinalysis Fetal heart tonesFetal heart tones Monthly visits to 28 weeksMonthly visits to 28 weeks Twice-a-month visits weeks 29 to 36Twice-a-month visits weeks 29 to 36 Weekly visits from week 37 to deliveryWeekly visits from week 37 to delivery (Cont’d…)

41. 41 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Antepartum Care Includes (…Cont’d) Code services not related to antepartum care separatelyCode services not related to antepartum care separately –ex., 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

42. 42 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Delivery Includes: Admission to hospital with admitting H&PAdmission to hospital with admitting H&P Management of uncomplicated laborManagement of uncomplicated labor Vaginal or cesarean section deliveryVaginal or cesarean section delivery –Complications coded separately Delivery Includes:Delivery Includes: –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

43. 43 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Postpartum Care Includes Hospital & office visits following deliveryHospital & 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:Normal follow-up care for 6 weeks after delivery: –e.g., Hospital visits, office visits –Not reported separately

44. 44 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Antepartum Services (59000-59076) Amniocentesis: Insertion of needle into pregnant uterus, withdraws fluid (59000)Amniocentesis: Insertion of needle into pregnant uterus, withdraws fluid (59000) –Ultrasound guidance with this service (76946) Component coding often part of services in subheadingComponent coding often part of services in subheading(Cont’d…)

45. 45 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Antepartum Services (59000-59706) (…Cont’d) Fetal services: Include stress tests, blood sampling, monitoring, and therapeutic servicesFetal services: Include stress tests, blood sampling, monitoring, and therapeutic services OB ultrasound codes: 76801-76817OB ultrasound codes: 76801-76817

46. 46 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Excision (59100-59160) Postpartum curettage: Removes remaining pieces of placenta or clotted blood (59160)Postpartum curettage: Removes remaining pieces of placenta or clotted blood (59160) Nonobstetric curettage: 58120 (Corpus Uteri, Excision)Nonobstetric curettage: 58120 (Corpus Uteri, Excision)

47. 47 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Introduction (59200) Insertion of cervical dilator: Used to prepare cervix for an abortive procedure or deliveryInsertion of cervical dilator: Used to prepare cervix for an abortive procedure or delivery Cervical ripening agents may be introduced to prepare cervixCervical ripening agents may be introduced to prepare cervix

48. 48 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cervical Ripening Figure: 8.8 Bishop Scoring System used to assess cervical ripeningBishop Scoring System used to assess cervical ripening

49. 49 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Repair (59300-59350) Only for repairs during pregnancyOnly for repairs during pregnancy Not for repairs done during delivery or after pregnancyNot for repairs done during delivery or after pregnancy

50. 50 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Routine Global Obstetric Care 59400, Vaginal delivery59400, Vaginal delivery 59510, Cesarean delivery59510, Cesarean delivery 59610, Vaginal delivery after previous cesarean delivery (VBAC)59610, Vaginal delivery after previous cesarean delivery (VBAC) 59618, Cesarean delivery following attempted vaginal delivery after previous cesarean delivery59618, Cesarean delivery following attempted vaginal delivery after previous cesarean delivery

51. 51 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Episiotomies and Use of Forceps From Roberts JR, Hedges JR, editors: Clinical Procedures in Emergency Medicine, ed 4, Philadelphia, 2004, Saunders. From Dorland's Illustrated Medical Dictionary, ed 31, Philadelphia, 2007, Saunders. Included in deliveryIncluded in delivery Not reported separatelyNot reported separately

52. 52 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Physician Provides Only Portion of Global 59409, Vaginal delivery only59409, Vaginal delivery only 59514, Cesarean delivery only59514, Cesarean delivery only 59612, Vaginal delivery only, after previous cesarean delivery59612, Vaginal delivery only, after previous cesarean delivery 59620, Cesarean delivery only, following attempted vaginal delivery, after previous cesarean delivery59620, Cesarean delivery only, following attempted vaginal delivery, after previous cesarean delivery

53. 53 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Delivery of Twins Payers differ on reporting formatPayers differ on reporting format –-22 (Unusual Procedural Services) –-51 (Multiple Procedures)

54. 54 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Abortion Services (59812-59857) Spontaneous: Happens naturallySpontaneous: Happens naturally Incomplete: Requires medical interventionIncomplete: Requires medical intervention Missed: Fetus dies naturally during first half of pregnancyMissed: Fetus dies naturally during first half of pregnancy Septic: Missed abortion with infectionSeptic: Missed abortion with infection

55. 55 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Abortion Services (59812-59857) Medical interventionMedical intervention –Dilation and curettage or evacuation (suction removal) –Intra-amniotic injections (saline or urea) –Vaginal suppositories (prostaglandin)

56. 56 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Conclusion CHAPTER 8 FEMALE GENITAL SYSTEM AND MATERNITY CARE AND DELIVERY