Ob-Gyn Coding Alert

Question: Patient is 17 weeks and has an incarcerated uterus. Physician was unable to manually correct in the office. Patient will be taken to the OR for ultrasound-guided reduction under sedation. What is an incarcerated uterus, and what CPT® code should I use?

Wisconsin Subscriber

Answer: Uterine incarceration is condition that results when a retroverted uterus fails to convert to an anteverted position so that the uterus can expand into the abdominal cavity as it grows.  In other words, the top of the uterus gets trapped below the sacrum, and pushing it back into the correct position is imperative to a continuing pregnancy. This situation can be treated surgically or by manual manipulation.

In this case, your physician has decided to try the manual approach, but of course there is no CPT^® code specific to this procedure.  Your physician is going to use sedation (for pain control), but also might give the patient a medication to relax the uterus. The manipulation involves using the fingertips to apply mild to moderate pressure to the fundus of the uterus via the posterior fornix to release it from the cul-de-sac where it is trapped. He may also use finger pressure via the rectum as well. He might also decide to apply ring forceps to the cervix to pull it toward the vaginal opening while pushing the down on the uterus.  In other words, the work involved will be variable. 

You will have to report the unlisted code 59899 (Unlisted procedure, maternity care and delivery) but the question is really what the comparison codes for this procedure are. The closest codes, would be 57415 (Removal of impacted vaginal foreign body (separate procedure) under anesthesia (other than local) at 4.56 RVUs), 57410 (Pelvic examination under anesthesia (other than local) at 3.09 RVUs, or 59412 (External cephalic version, with or without tocolysis at 3.02 RVUs. In addition, you would report 76998 (Ultrasonic guidance, intraoperative) for the guidance.