Ob-Gyn Coding Alert

Question: Patient has perineal scarring after traumatic vaginal delivery repaired with perineoplasty. I have a couple of questions regarding what codes to use. Patient delivered on 10/1/12, and we are doing repair on 1/9/13 so we are past a typical postpartum period. However, the issue is due to the delivery. Do I use 59300 with 664.14 for this procedure or 56810 with some other diagnosis like 623.8? 

California Subscriber

Answer: Neither. First, you are not doing an episiotomy immediately following delivery (which is the purpose of 59300, Episiotomy or vaginal repair, by other than attending), and if you billed for the delivery, 59300 will be denied no matter when billed. 

And you cannot report 56810 (Perineoplasty, repair of perineum, nonobstetrical [separate procedure]) because CPT^® only allows this code to be used for non-obstetric conditions. 

So for this repair use the integumentary repair codes based on the type of repair (simple [12001-12007], intermediate [12041-12047], or complex [13131-13132]), and as she appears to be out of the global period for 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care), no modifier is required.

Your diagnosis will be 664.14 (Second-degree perineal laceration postpartum) as you have suggested if this was a second-degree laceration, but was following delivery and it was not previously repaired. Your diagnosis also might be 674.24 (Disruption of obstetrical perineal wound postpartum) if the scarring was due to the episiotomy repair at the time of delivery which now needs to be fixed. This code covers secondary repair, which essentially is what they had to do even though you have not indicated that the wound was coming apart.

ICD-10: When your diagnosis coding system changes, 664.14 will become O70.1 (Second degree perineal laceration during delivery). Code 674.24 will become O90.1 (Disruption of perineal obstetric wound).