Wiki Cerclage Removal

[bessie_199@yahoo.com]

I am trying to find out if it is appropriate to bill this cerclage removal.

The cerclage removal took place on 1/7/2025 and the patient did not deliver until 1/25/2025.

Typically, if the removal is done the day before or day of the delivery, it would bundle and we would not bill separately.

This snippet from 3M states "However, removal of cerclage suture under anesthesia before the onset of labor, or at a time that extends beyond the global period of the placement procedure is reported separately with 59871." I looked it and I see no global period.

Can we bill for the cerclage removal? The other caveat is that the provider used local anesthesia which codes to the unlisted code - 59899. If we can bill for it, which CPT code should be used?

Please let me know your thoughts! Thank you!

 

[csperoni]

These AAPC references are ancient, but I believe they are still accurate.

https://www.aapc.com/codes/coding-newsletters/my-ob-gyn-coding-alert/you-be-the-coder-cerclage-removal-article?srsltid=AfmBOoqpeLK8k2RUFgd0S7jVjhhS5jWOhb7lUXtbsbZ3TpefvuHpB2lq

https://www.aapc.com/codes/coding-newsletters/my-ob-gyn-coding-alert/you-be-the-coder-cerclage-removal-under-anesthesia-article?srsltid=AfmBOorjRyEfM901EBi7CCPAB9uiPDYuuOicDwfkNBXOaOnOixtRtyg8

Bottom line - if your physician placed the cerclage, removal would be included. If another physician placed, the work would be included in E&M.

 

[bessie_199@yahoo.com]

These AAPC references are ancient, but I believe they are still accurate.

https://www.aapc.com/codes/coding-newsletters/my-ob-gyn-coding-alert/you-be-the-coder-cerclage-removal-article?srsltid=AfmBOoqpeLK8k2RUFgd0S7jVjhhS5jWOhb7lUXtbsbZ3TpefvuHpB2lq

https://www.aapc.com/codes/coding-newsletters/my-ob-gyn-coding-alert/you-be-the-coder-cerclage-removal-under-anesthesia-article?srsltid=AfmBOorjRyEfM901EBi7CCPAB9uiPDYuuOicDwfkNBXOaOnOixtRtyg8

Bottom line - if your physician placed the cerclage, removal would be included. If another physician placed, the work would be included in E&M.

Is there any reference that says its included? I am reviewing the lay description for 59320 for cerclage insertion but it does not mention the cerclage removal is bundled.

The first link you attached says it would bundle if it's done in office but this procedure was done in the hospital with local anesthesia. Any other thoughts?

 

[nielynco]

Is there any reference that says its included? I am reviewing the lay description for 59320 for cerclage insertion but it does not mention the cerclage removal is bundled.

The first link you attached says it would bundle if it's done in office but this procedure was done in the hospital with local anesthesia. Any other thoughts?

Per the 2007 CPT Assistant:
Question

How is the removal of cerclage sutures reported?

AMA Comment

Cerclage of the cervix during pregnancy is reported by means of codes 59320, Cerclage of cervix, during pregnancy; vaginal, and 59325, Cerclage of cervix, during pregnancy, abdominal. The appropriate code is selected on the basis of the approach used to perform the procedure, ie, either the vaginal or abdominal approach. Subsequent removal of cerclage sutures at the time of delivery is considered part of the delivery and would not be reported separately. However, removal of the cerclage suture under anesthesia before the onset of labor, or at a time that extends beyond the global period of the placement procedure, is reported separately with code 59871, Removal of cerclage suture under anesthesia (other than local).

As you can see, they refer to "other than local" for the removal so if done with a local it would only be part of an E/M service, not 59871 for the removal. There is no global period attached to 59320 so if removed the next day or before the onset of labor you could report this removal with 59871 but only if a general anesthesia was used - for local only default to an E/M service.