Ob-Gyn Coding Alert

Question: What CPT codes should I use for a second-, third-, or fourth-degree laceration?
California Subscriber Answer: For a second-degree laceration, you should not use a CPT code. You should include this service with the global ob package code (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) or the delivery code (such as 59409, Vaginal delivery only [with or without episiotomy and/or forceps]).
For a third- or fourth-degree laceration, you have three options:
Option 1: You can add modifier 22 (Increased procedural services) to the delivery or global code.
Option 2: You can try the integumentary repair codes for an anal or perineal tear (12041-12047, Layer closure of 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). Your physician will have to document the size of the wound he repaired to select the correct code.
You should code the repair of a cervical tear as 57720 (Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach).
Option 3: Use unlisted-procedure code 59899 (Unlisted procedure, maternity care and delivery) for vaginal wall tears, because you have no specific codes for this type of obstetric tear. The physician who performs the delivery cannot separately report the obstetric vaginal repair code (59300, Episiotomy or vaginal repair, by other than attending physician).