Ob-Gyn Coding Alert

Question: The patient was 23 weeks pregnant with premature rupture of the membranes. She was also diagnosed with chorioamnionitis, postpartum bleeding, anemia and a possible ruptured uterus. She had a spontaneous vaginal delivery in breech presentation and had manual removal of the placenta and curetting. Later the physician performed an exploratory laparotomy with total abdominal hysterectomy. How should I code the surgery?

Michigan Subscriber

 
Answer: Assuming that the patient was under global care by the physician and that she had not undergone a previous cesarean delivery, use 59400 (routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). The diagnostic code is based on how long the membranes were ruptured before delivery.

652.21 breech presentation without mention of version; delivered, with or without mention of antepartum condition and a secondary diagnosis of either

644.21 early onset of delivery; delivered, with or without mention of antepartum condition

658.11 premature rupture of membranes; delivered, with or without mention of antepartum condition or

658.21 delayed delivery after spontaneous or unspecified rupture of membranes; delivered, with or without mention of antepartum condition.  
 
You would also use a V code for the outcome of delivery, most likely V27.0 (single liveborn).
 
For the curettage, use 59160 (curettage, postpartum) with a diagnosis of 666.02 (third-stage hemorrhage; delivered, with mention of postpartum complication), then bill 58150-78 (total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]; return to the operating room for a related procedure during the postoperative period) to indicate a complication of the delivery. The diagnosis code may be uterine rupture. If this is the case, use 665.12 (rupture of uterus during labor; delivered, with mention of postpartum complication). Or, you could also use the same diagnosis as for the curettage, 666.02.