Ob-Gyn Coding Alert

Question: How would you code a defibulation-refibulation repair for an acquired abnormality due to ritual female circumcision in childhood? Is it payable by insurance if done postpartum upon request of patient?

Andrew Mendoza
University Physicians Inc.
Baltimore, MD

Answer: Ritual female circumcision is the cultural practice of removing all or part of the external vulvar and clitorial tissue and in some cases (as with the patient in question), the infibulation, or sewing shut of the vagina, with a small hole, or introitus left open for the passage of urine and menstrual blood. In several African and West Asian cultures, the practice is considered an essential rite of passage into womanhood for young girls.

In this case, the woman was about to deliver her fourth child and prior to delivery, was defibulated, or opened in order to ease the passage of the fetus through the birth canal.

At the patients request, a postpartum refibulation was performed. Ritual procedures such as this are not payable by insurance companies, and payment for this service should be negotiated with the patient. The proper code for the refibulation procedure is 58999 (unlisted procedure, female genital system nonobstetrical).