Ob-Gyn Coding Alert

Question: The patient delivered vaginally (59400) and then had a complication, which required a uterine replacement with the assistance of a Bakri intrauterine balloon. How would I code this?

Kentucky Subscriber

Answer: If the physician performed this procedure before she went to recovery, add a modifier 22 (Increased procedural service) to 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care).

If the physician performed the procedure after that and she had to be returned to the OR, you should use the unlisted code 59899 (Unlisted procedure, maternity care and delivery) with 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).

The amount of work you can compare this to will be based on what the ob-gyn documented, but some codes with RVUs that your physician should review for work equivalency include:

• 43460 (Esophagogastric tamponade, with balloon [Sengstaken type]),
  
• 46604 (Anoscopy; with dilation [e.g., balloon, guide wire, bougie]) and
  
• 51703 (Insertion of temporary indwelling bladder catheter; complicated [e.g., altered anatomy, fractured catheter/balloon]).
  

This is a decision only the surgeon can make.