Ob-Gyn Coding Alert

Answer: No, the delivery includes the episiotomy repair. If the repair is extensive, however, you have a case for adding modifier -22 (Unusual procedural services) to the delivery code (59400, 59409-59414). For example, if the episiotomy results in a third-degree laceration, you could report 59400-22 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care).

As with any modifier -22 claim, you should attach a letter stating exactly what made the procedure unusual, including the extenuating circumstances and the extra work and time involved.