Wiki 1st / 2nd Degree Lacerations During Delivery

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acooper1

acooper1

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Good Evening!

I am reading mixed messages on whether or not coding repairs of lacerations is allowed.

I have read some examples that say 1st and 2nd degree laceration repairs should not be coded; only 3rd and 4th.

I have also read that 1st and 2nd degree can be coded.

Aside from what the payers want specifically, what is the 'coding standard' for applying additional codes for 1st or 2nd degree lacerations when they occur during delivery?

Thanks so much!

A. Cooper
 
There is no coding standard because there is no code. There global OB package is published by the ACOG. Its what most payers follow as well. First and second degree lacerations in the global maternity package and the delivery only codes. Third or fourth add modifier 22.
 
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Are you billing for the Hospital or the Physician? There are ICD-10-PCS codes for inpatient facilities but they go on the UB form and not on the professional claim. Its quite different from professional since Facilities are paid based on resources not the individual procedures done, which could affect DRG assignment. There are ICD-10-CM diagnosis codes as well but that doesn't affect reimbursement on Professional and is more of just for statistics purposes. The presentation references is for Facility Charges so if you are billing for professional (CMS-1500) that could be a source of confusion.
 
acooper1 said:
I am billing for Physician Services
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Thats what i was thinking when you mentioned 1st/2nd vs 3rd/4th which is pretty much an industry standard for professional. Other than the O70.- diagnosis code you can ignore the entire presentation as it's not meant for professional coding. Facility is a completely different animal where you bill for the end result of the procedure and not what is done to accomplish it.


Plus I was incorrect about no CPT code for the repair. That is 59300 but NCCI bundles it into the delivery or the Global OB so reimbursement will never be made on the code even if modifier used
 
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