Ob-Gyn Coding Alert

Question: A patient had a vaginal delivery. One hour later she was having a PP hemorrhage. The patient was brought back to the OR where she underwent an exam under anesthesia, repair of posterior uterine wall laceration, and vaginal packing. The laceration was of the intravaginal portion of posterior uterine wall and was 3 cm in length. My doctor was then notified later on that the patient was still having persistent bleeding coming past the vaginal packing, and the patient went back to the OR again where she underwent EUA. There was noted to be a laceration of the right lateral cervical wall that was bleeding minimally and was repaired with 2-0 Vicryl continuous locking suture. Continued bleeding was noted coming from a posterior location where further exam revealed laceration of the posterior cervical wall mucosa approximately 3cm in length that was actively bleeding extending just to the posterior fornix. The lateral fornices were noted to be intact. This latter laceration was repaired with #2-0 Vicryl continuous suture. What CPT^® codes should I use for the repair of the cervical lacerations, and do I code separately for them?

Coding Institute Forum Subscriber

Answer: The examination under anesthesia (EUA) and vaginal packing are bundled if you bill for a repair, but the closest code would be 59350 (Hysterorrhaphy of ruptured uterus) for the laceration of the uterus. Keep in mind, however, the uterus was not ruptured and so you may have to use the unlisted code instead, 59899. Also this code has a fairly high relative value unit (RVU of 8.16) which may not be supported if the op note describes only a single layer repair.

And for the return, try using the code for trachelorrhaphy (57720, Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach). It appears that both the remaining issues involved the cervix.