Ob-Gyn Coding Alert

Question: How do I code an assist during a c-section?

Kathy Graves, Business Office Manager
Everett Family Practice Center, Everett, WA

Answer: The general CPT rule for coding an assistant at surgery is to add a modifier -80 (or -82 if there was no qualified resident in a teaching facility situation) to the surgical procedure code reported by the primary surgeon. The payer in turn reimburses some percentage of the allowable for the modified code because the assistant provides a lesser service, and does not provide any postoperative services (which are included in the allowable for the procedure).

The cesarean delivery codes should be the exception to this rule, however, because the global period is nine months long and the global code normally reported by the delivering ob includes other services not provided by the assistant such as prenatal care. ACOG believes that the assistant should report the cesarean delivery only code (59514 or 59620) with the appropriate surgical assistant modifier because assistance was not rendered over the course of the entire global period. If the payer does not search for code matches between the primary and assistant surgeons, this coding approach will not complicate payment for the service. If the payer does look for exact matches, additional documentation may be required or the insurer may initially deny one of the claims. To avoid payment delays, it is always a good idea to find out how the insurer would like the service billed.