Ob-Gyn Coding Alert

Question: Could you help me code this control of bleeding case?

Doctor states: “33 weeks and 3 days obstetrical patient has colposcopy and an abnormal-appearing cervix was visualized and single biopsy was taken at approximately 10 o’clock position on cervix. Directly following biopsy significant bleeding could not be stopped with pressure so patient was taken to OR and vaginal packing was removed from the vagina and a speculum placed into vagina as well as sponge stick to apply pressure to the laceration which was actively bleeding. Suction was used in order to achieve visualization of cervix, a ring forceps was then used to grasp the area of the cervical laceration to achieve hemostasis. At that time, Floseal solution was used generously, after waiting a moment ring forceps were then carefully removed from the cervix and Floseal solution dried, hemostasis was achieved, instruments counted, procedure concluded.”

Should I code this using an unlisted code and compare to CPT^® 57720?

Ohio subscriber

Answer: You should consider control of bleeding following any procedure as integral to the procedure. That said, you should simply append modifier 22 (Increased procedural service) to the colposcopy code (57455, Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix). Be sure to send in documentation relaying the circumstances and see what happens.

However, you should not compare the additional work to 57720 (Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach) as no suturing took place. The work is much more closely associated with 57180 (Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure)).

Best bet: Have your ob-gyn indicate how long it took to get the bleeding under control. This will help substantiate your claim.