Ob-Gyn Coding Alert

Question: My ob-gyn treated a patient with sudden vaginal delivery (SVD) with a repair of a fourth degree laceration. I submitted the claim with 59400 and 59300-59. The insurance denied 59300 as inclusive. Should I separately report the fourth degree repair, and if so, how?

North Carolina Subscriber

Answer: You should always consider 59300 (Episiotomy or vaginal repair, by other than attending physician) as an integral part of the global code (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). The reason is an episiotomy (which usually equates to a first or second degree tear) is part of the delivery fee, when an ob-gyn performs it. Notice how 59300's descriptor says "other than attending physician."

Option: You can also append modifier 22 (Increased procedural service) to the global code to represent this work, but your ob-gyn's documentation must support it. Another option is if you know the size of the repair, you can bill separately for it using the integumentary repair codes, for instance, (12041-12047 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia...), or 13131-13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet...)