Ob-Gyn Coding Alert

Question: If the ob-gyn performs a vaginal delivery and then takes the patient to the operating room one hour later to manually remove the placenta, should I report that separately? He also performed a dilation and curettage (D&C). Should I code this as 59414 and 59160?

Arizona Subscriber

Answer: If you are reporting the delivery (for example, 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care), you cannot bill separately for removing the placenta (59414, Delivery of placenta [separate procedure]). On the other hand, if the physician's documentation clearly shows significant additional work, you can add modifier -22 (Unusual procedural services) to the delivery code.
 
Nevertheless, you would bill the D&C (59160, Curettage, postpartum) separately. If the ob-gyn removed the placenta and performed the D&C during the same surgical session, you may have to report it as 59160-78-22 (Return to the operating room for a related procedure during the postoperative period) instead of adding modifier -22 to the delivery code. Of course, making your case to the payer will depend entirely on the physician's documentation.