Ob-Gyn Coding Alert

Question: After our physician performed a normal vaginal delivery, there was a postpartum complication. The patient had a complete uterine inversion. Our physician had to manually replace the uterus into position, requiring general anesthesia and three units of blood replacement. Is there a procedure code or is this part of the global package?

Marilyn Withrow
MacNeal OB/GYN
LaGrange, Ill.

Answer: The global service for a vaginal delivery includes only normal, uncomplicated antepartum, delivery and postpartum care. A uterine inversion is definitely not considered normal or uncomplicated. Unfortunately, you will have to code the manual replacement of the uterus as 59899 (unlisted procedure, maternity care and delivery). CPT 2000 does not have a specific code to describe this service. To obtain reimbursement for this procedure, you will have to attach a copy of the operative note with the claim.

Hopefully your physician has documented the entire procedure and the time and effort required. The insurance carrier will most likely deny payment. Dont give up easily: Appeal. Appeal. Appeal. Have your physician write a letter of medical necessity if needed to explain how he not only saved the patients life but also saved the insurance company money. After all, this patient would have most likely ended up with a hysterectomy, which would have cost the insurance company more money, had it not been for the actions of a competent physician.

Source for reader questions: Cynthia DeVries, RN, BSN, CPC, coordinator of coding and reimbursement for Lee Physician Group, a 140-physician multispecialty group that includes 25 ob/gyn providers in Fort Myers, Fla., and member of AAPC.