Ob-Gyn Coding Alert

Question: Patient had a D&C for a MAB on 4/11. On 4/17, returned to the ER with fever and pain. A repeat D&C for retained POC was done along with a small laparotomy repair. “The hysterotomy was visualized and a stratisfix suture was used to suture the hysterotomy closed in a running fashion. Reapproxi­mation and hemostasis were excellent.” What code do you recommend for the perforation repair?

Iowa Subscriber

Answer: In this case, you have a nick in the uterus that was repaired, so you should stick with the D&C code (59812, Treatment of incomplete abortion, any trimester, completed surgically and maybe consider a modifier 22 (Increased procedural service) for the additional work. Remember, you need supporting documentation.

You will find a code for hysterorrhaphy (59350, Hysterorrhaphy of ruptured uterus), but this implies that the uterus ruptured due to pregnancy and not due to the D&C the o-gyn performed. You should also consider this to be an open abdominal procedure. This code has 7.38 RVUs, and from your description, the work performed does not seem to be that extensive.

Best bet: You should clarify the circumstance of this laceration with the provider before billing.