1. CHAPTER 25
REPRODUCTIVE, INTERSEX SURGERY, FEMALE GENITAL SYSTEM, AND MATERNITY CARE AND DELIVERY
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2. Reproductive System Procedures (55920)
Reports placement of catheters/needles into pelvic organs/genitalia for subsequent interstitial radioelement application
What is the time required to complete intersex surgery? (Extended period of time)
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3. Intersex Surgery (55970, 55980)
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
How many codes are contained in the Intersex Surgery subsection? (Two codes)
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4. Female Genital System 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)
Figure: 25.1A
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5. Female Genital System Subheadings
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.)
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6. Vulva, Perineum, and Introitus
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.)
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7. Incision Category ( )
I&D of abscess: Vulva, perineal area, or Bartholin’s gland
Marsupialization:
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)
From Andrews G, editor: Women’s Sexual Health, ed 3, 2005, Elsevier.
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8. Destruction (56501, 56515) Lesions destroyed by variety of methods
Destruction = Eradication not excision
Excision is removal
(Cont’d…)
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)
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9. Destruction (56501, 56515) Divided by simple or extensive destruction
(…Cont’d)
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
56501/56515 have a global period of 10 days on Medicare Fee Schedule
If the patient returns in 2 days for a re-check, it is included in payment for original procedure
Destruction: No pathology report
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.)
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10. Excision (56605-56740) Biopsy includes:
Local anesthetic
Biopsy
Simple closure
Code based on number of lesions
Place number of lesions on CMS-1500 in 24G
(Cont’d…)
Two biopsy codes are included in the CPT: to code biopsy of the first lesion, and to code biopsies of the second and subsequent lesions.
The number of units (lesions biopsied) should be indicated in box 24G, of the CMS-1500 form.
Why is it important to indicate the number of units for the biopsy procedure? (This will be used to determine reimbursement levels.)
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11. Excision ( )
(…Cont’d)
Codes & are designated “separate procedures”
If another service code from female genital subsection performed at same session, “separate procedure” codes would not be billed separately
56606 is add-on (+) code and describes each separate additional lesion biopsied from vulva/perineum
Code cannot stand alone, must be billed with 56605
Vulvectomy: Surgical removal of portion of vulva ( )
Based on extent and size of area removed
(Cont’d…)
A vulvectomy is typically used to treat malignant or premalignant lesions. The vulvectomy codes ( ) 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.)
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12. Excision (56605-56740) Extent is:
(…Cont’d)
Extent is:
Simple: Skin and superficial subcutaneous tissues
Radical: Skin and deep subcutaneous tissues
(Cont’d…)
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.
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13. Excision (56605-56740) Size: Extent and size, on operative report
(…Cont’d)
Size:
Partial: <80% vular area
Complete: >80% vular area
Extent and size, on operative report
Some vulvectomy codes include lymphadenectomy ( , )
Code is unilateral procedure and has no code to describe bilateral
Bilateral, report
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)
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14. Repair (56800-56810) 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 the introitus, clitoroplasty, and 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.
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15. Vagina ( )
Codes divided based on service (e.g., incision, excision)
How are codes for the Vagina subheading divided? (On the basis of the service delivered)
Two often confused procedures are coded within this subheading:
Colpotomy ( ): cutting into the vagina to gain access to the pelvic cavity.
Colpocentesis: an 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.
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16. Introduction ( )
Figure: 25.5
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 into procedure code and A4261 is non-covered
Code has a 10-day global period
The Introduction category of the Vagina subheading includes codes for three main types of procedures:
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 (for vaginal hemorrhage).
How are the codes in this category organized? (According to the type of procedure performed)
Vaginal pessary (Arabin type). (Modified from Gabbe SG, Niebyl JR, Simpson JL: Obstetrics: Normal and Problem Pregnancies, ed 5, Philadelphia, 2007, Churchill Livingstone.)
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17. Repair (57200-57335) 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)
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18. Manipulation ( )
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 involve dilation (stretching), pelvic examination, and 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 of the CPT.
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19. 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 in the CPT.
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? (A 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.)
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20. Colposcopy Colposcopy enables physician to view an endocervical polyp
Figure: 25.6
How does use of a colposcope aid the physician? (The colposcope enables the physician to directly view changes in the vagina and cervix.)
From Baggish MS: Colposcopy of the Cervix, Vagina, and Vulva: A Comprehensive Textbook, Philadelphia, 2003, Mosby.
Colposcopy enables physician to view an endocervical polyp
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21. Cervix Uteri ( )
Figure: 25.1A
Codes for endoscopy, excision, repair, and manipulation are included under this subheading.
Note its location in diagram A in Fig. 20–1.
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.)
Cervix uteri, narrow, lower end of uterus; services include endoscopy, excision, manipulation, repair
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22. LEEP
LEEP, LETZ, or cervical loop diathermy relatively new office procedure
The LEEP/LETZ/cervical loop diathermy procedure is a relatively new office procedure:
As shown in Fig. 20–7, it involves use of an electrosurgical loop attached to an electric generator. The generator heats the wire, which is then drawn across the affected area of the cervix in order to remove a slice of tissue for examination by a pathologist.
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.)
Figure: 25.7
From Llewellyn-Jones D: Fundamentals of Obstetrics and Gynaecology, ed 7, 1999, Mosby Ltd.
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23. Excision (57500-57558) 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.)
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24. Corpus Uteri (58100-58579) 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.)
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25. Excision (58100-58294) Dilation and curettage (D&C, 58120) of uterus
After dilation, curette scrapes uterus
Do not report postpartum hemorrhage service with 58120
Use 59160—Maternity and Delivery code
(Cont’d…)
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)
From Chabner DE: The Language of Medicine, ed 8, St. Louis, 2007, Saunders.
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26. Excision (58100-58294) Many hysterectomy codes (…Cont’d)
Based on approach (vaginal, abdominal) and extent (uterus, fallopian tubes, etc.)
(Cont’d…)
Hysterectomy codes represent most of the codes in this heading.
Hysterectomy always involves removal of the uterus, but there are many variations.
Hysterectomy codes: 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.)
Total hysterectomy. (Modified from Chabner DE: The Language of Medicine, ed 8, St. Louis, 2007, Saunders.)
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27. Excision ( )
(…Cont’d)
Often secondary procedures performed with hysterectomy
Do not code secondary related minor procedures separately
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)
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28. Introduction (58300-58356) Common procedures
Figure: 25.10
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
(Cont’d…)
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 from the Medicine section, the standard code for non-included materials and supplies used by the physician during a procedure.)
From Chabner DE: The Language of Medicine, ed 8, St. Louis, 2007, Saunders.
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29. Introduction (58300-58356) Component coding
(…Cont’d)
Component coding
Necessary with catheter procedures for hysterosonography
Notes following codes indicate radiology guidance component codes
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.)
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30. Laparoscopy/Hysteroscopy (58541-58579)
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.)
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31. Laparoscopy Through abdomen (Cont’d…) Figure: 25.11
Laparoscopy is used increasingly to complete procedures that previously required open surgical intervention (see Fig. 20–11).
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.)
Figure: 25.11
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32. Laparoscopy/Hysteroscopy (58541-58579)
(…Cont’d)
Figure: 25.12
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. Further divided by weight of the uterus and if removal of tubes and ovaries were also performed.
Hysteroscopy through uterus. Surgical laparoscopy with vaginal hysterectomy, 58550
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33. Oviduct/Ovary (58600-58770) 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.)
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34. Laparoscopy (58660-58679) Based on purpose of procedure
e.g., Lysis, lesion removal
Caution: If only diagnostic laparoscopy:
Do not use Female Genital System codes
Use 49320, Digestive System
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.)
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35. Ovary Two categories only: Incision and Excision
Incision: Primarily for drainage of cysts and abscesses
Divided on surgical approach
Excision: Biopsy, wedge resection, and oophorectomy
Two categories of codes in the Ovary subheading:
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.)
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36. In Vitro Fertilization (58970-58976)
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.
How are codes for in vitro fertilization divided? (By type of procedure and method used)
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37. Maternity Care and Delivery (59000-59899)
Divided by service:
Antepartum services
Amniocentesis
Fetal non-stress test
Type of delivery
Vaginal delivery
C section
Delivery after C section
Abortion
The Maternity Care and Delivery subsection ( ) is divided according to type of procedure.
In general, codes progress from those used in the antepartum period through delivery, onto the procedures of the postpartum period.
Abortion codes are found at the end of the subsection.
What are the main categories of the Maternity Care and Delivery subsection? (Antepartum Services, Vaginal Delivery, Cesarean Delivery, Abortion)
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38. Maternity Care and Delivery Notes
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.)
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39. Gestation Fetal gestation: Approximately 266 days (40 weeks)
EDD: Estimated Date of Delivery
280 days from last menstrual period (LMP)
Why is the estimated delivery date calculated to be 280 days from the LMP if gestation is 266 days? (Because conception is assumed to occur 14 days after the LMP)
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40. Trimesters First: LMP to Week 12 Second: Weeks 13-27
Third: Week 28-EDD
How long is the first trimester? (Approximately 14 weeks; it includes the first 12 weeks of pregnancy and the 2 weeks preceding conception.)
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41. 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?
59400 Vaginal delivery; Cesarean delivery; Vaginal delivery after a previous cesarean delivery (VBAC); Cesarean delivery following an attempted vaginal delivery after previous cesarean delivery.
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.
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42. Antepartum Care Includes
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
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) 37
(Cont’d…)
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43. Antepartum Care Includes
(…Cont’d)
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
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.)
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44. Delivery Includes: 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.)
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45. 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.)
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46. 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
(Cont’d…)
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)
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47. Antepartum Services (59000-59076)
(…Cont’d)
Fetal services: Include stress tests, blood sampling, monitoring, and therapeutic services
OB ultrasound codes:
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)
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48. Excision ( )
Postpartum curettage: Removes remaining pieces of placenta or clotted blood (59160)
Nonobstetric curettage: (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.)
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49. Introduction (59200)
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.)
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50. Cervical Ripening
Figure: 25.17
Bishop Scoring System used to assess cervical ripening
Consider Fig. 20–17: Which factors contribute to the assessment of cervical ripening in the Bishop Scoring System? (The score is based on dilation, effacement, station, consistency, and cervical position.)
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51. 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.)
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52. 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.)
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53. 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.)
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.
Figure: 25.13
Figure: 25.14
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54. Physician Provides Only Portion of Global Care
59409, Vaginal delivery only
59514, Cesarean delivery only
59612, Vaginal delivery only, after previous cesarean delivery
59620, Cesarean delivery only, following attempted vaginal delivery, after previous cesarean delivery
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.)
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55. Delivery of Twins Payers differ on reporting format
-22 (Unusual Procedural Services)
-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? (The modifier -22 is used to report these services.)
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56. Abortion Services (59812-59857) Spontaneous: Happens naturally
Incomplete: Requires medical intervention
Missed: Fetus dies naturally during first or second trimester
Septic: Missed abortion with infection
When are abortion services required? (Whenever a fetus is expelled from the uterus [completely or partially] either naturally or through medical intervention)
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57. Abortion Services (59812-59857) Medical intervention
Dilation and curettage or evacuation (suction removal)
Intra-amniotic injections (saline or urea)
Vaginal suppositories (prostaglandin)
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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58. Conclusion CHAPTER 25
REPRODUCTIVE, INTERSEX SURGERY, FEMALE GENITAL SYSTEM, AND MATERNITY CARE AND DELIVERY
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