# CPT coding for inducing labor



## lindab

What CPT code would you use for inducing labor in a Birthing Center using a foley cath?  Any thoughts would help, thanks.


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## Mojo

59200 Insertion of cervical dilator is the code for the foley balloon insertion into the endocervix, promoting cervical ripening when inflated. It probably is part of the obstetric package and may not be billable.


For instance:
FL BCBS 
Billing Requirements
Birthing centers are reimbursed with the following codes and/or modifiers. 
59400 SB 
59425-26 SB 
59430 SB 
76805 
J2790 
99201-99205 
99211-99215 

http://providermanual.bcbsfl.com/ARS/cr/bg/Pages/Birthing-Centers.aspx#Billing_Requirements


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## preserene

The purpose of introducing Foley's catheter into the uterine cavity (extra amniotic), is to stimulate the uterus to release of prostaglandin to intiate the labor/abortion, whatever the case is.- INTRODUCTION/INDUCTION; , BUT NOT INSERTION OF DILATORS, WHICH DO THE JOB JUST DILATING THE CERVIX
So it is *like prostaglandins/ hypertonic solution introduction to initiate labor*. The CPT guide line guides us to *SEE 59850-59857*.
The introduction, initiation of labor  and delivery* mandatorily involves hospital admission. 
So I would lean on to 59855..*


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## Mojo

https://provider.medmutual.com/TOOLS_and_RESOURCES/Care_Management/MedPolicies/PDF/94041.pdf

Insertion of any cervical dilator such as laminaria, prostaglandins or a foley bulb into the endocervix to stimulate the dilation of the cervical canal should be submitted with CPT code 59200.


Per CMS: 
http://www.cms.gov/MedHCPCSGenInfo/Downloads/SO-May12th-sum.pdf

Foley catheters have been used in a similar fashion, but cervical ripening by Foley catheter is an off-label use of the device. According to the requester, CPT code 59200 "INSERTION OF CERVICAL DILATER (E.G., LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE)" describes the procedure.


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## preserene

It is not for mechanical stimulation of dilation Cervix.
'Intrauterine Bougie' it is called- is introduced still further from endocervix and internal Os into the Uterine Cavity-extraamniotic placement to release syntocinon/pitocin to bring about uterine contraction.
The machanical cervical dialtors only dilate the cervix. they do not bring forth relase of pitocin to produce contraction


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## Mojo

Actually, the pressure of the balloon on the lower uterus possibly produces local prostaglandins.

Preserene, this isn't a forum for diagnosing and treating medical conditions at the cellular level; it is an online discussion site to support one another and exchange coding and billing methodologies.


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## preserene

Oh come on, I am not trying to diagnose a condition or treat it.
I am giving the suggestion to correlate the documented clinical condition and the documented procedure in the birthing center and translate it on to the highest specificity code with compliance to the guide line, 
which clearly states " The CPT guide line guides us to SEE 59850-59857, for introduction of hypertonic solution and or prostaglandins  to initiate labor  SEE 59850-59857". 
Bougie, intrauterine hypertonic solution and intrauterine porstaglandin are to bring about uterien contraction and go into labor/abortion.
The intention of Bougie into the uterus( Foleys in to the uterus) is TO INITIATE LABOR  and not for dilation of the cervix.
"Dilation of cervix" by dilators cannot be equated to "Initiation of labor" through uterine injection or bougie placement for bring forth uterine contraction.
Both are different procedures with different intention and mechanism of action an dplac eof service. Bouigie must be in birthing center and monitored with admission till delivery.
My intention was to try to get the highest specificity code. 
Well payers accept that, that is our ultimate end product of OUR purpose being there. Good!!
Thanks for your advice.


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## lscott

According to ACOG guidelines, induction of labor (unless the obstetrician personally starts the intravenous line and sits with the patient during the infusion, then use codes 90780-900781); and insertion of cervical dilator on same day as delivery are included in the delivery code.  Insertion of a cervical dilator by the physician on a day before the delivery is separately billable.  I've not heard of one using a Foley cath to induce labor, that's a new one on me.  I would say the same rules apply:  if the physician inserted the cath herself and stayed with the patient, then it I would think it would be billable.


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## preserene

There are many ways of inducing labor- You are taliking about the induction by syntocinon /pitocin IV drip which needs the doctor to sit with.
This induction is with just inserting the Foleys into the uterus through the external os and through internal os an dthen inflating the bulb with water or saline  (all without dilating the cervix)hwile it is secured inside the uterus. patiients take many hours even 48-72hours to deliver. The foleys gets EXPELLED ALONG with the fetus, and sometimes during course of la
bor.
 BOTH METHODS INVOLVES HOSPITAL ADMISSION but cervical dilators do not need admission.

This procedure is very effective and undertaken when other methods fail /or when predicted to fail. Most often it is selected for IUFD grade 2 or 3, which is not responsive /or refractory to deliver. But it is undertaken for live fetus induction labor also as I mentioned earlier.
The bottomline is, it is found to intiate the uterine lining to produce ample of  prostoglandins- which in turn stimulates the production of pitocin to intiate labor. 
I hope it helps now to understand better.


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## lilprincess75067

*Foley insertion for delivery*

59855 is to induce an abortion, not to induce active labor to deliver a live fetus.  An abortion is not done in the third trimester.
59200 for cervical dilator would be the correct code.


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