Ob-Gyn Coding Alert

Question: How does a physician bill for a deep sulcus tear repair when she was called in following a midwife delivery from the same practice? This is a midwife obstetrics delivered the baby, and the MD from practice did the repair in the operating room (OR) under anesthesia.

Iowa Subscriber

Answer: A sulcus tear is one of the vaginal canal, and the code 57200 (Colporrhaphy, suture of injury of vagina (nonobstetrical)) would seem ideal, but it is only for a non-ob related injury.

So you would have to code this as an unlisted procedure (59899, Unlisted procedure, maternity care and delivery) with a modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period) if performed on the same date of service as the delivery. You should compare this code with 57200.

You would not want to use the code for episiotomy as this code is bundled into all deliveries. It is your practice that is billing the delivery and you have indicated that the obstetrician is also a member of your practice.