Wiki Cervical Laceration after Vaginal delivery

[dmarshall]

Called to bedside by nursing secondary to patient having large amount of bleeding after delivery. Presented to bedside immediately. Patient was laying supine and blood pressure noted to be 80s/40. Second bag of pitocin was running. Chuck pad underneath patient had approx. 1000 mL of blood clot with continued bleeding noted from vagina. Performed manual sweep with uterus noted to be boggy. Bimanual uterine massage was initiated. Uterus noted to continue to be boggy after several minutes of continued uterine massage. Jane Doe, CNM, presented to bedside. Patient was then given 0.2 Methergine and 1000 mcg Cytotec PR. Additionally bimanual sweeps were performed. 4mg Morphine given for pain control. Cervical was inspected, however, it difficult to visualize the entire cervix. Foley catheter was placed to assist with contraction of lower uterine segment. Bimanual massage was continued with multiple large clots expressed. 1g TXA was given at this time. Patient was placed into stirrups for better visualization. Patient's uterus began to gain tone, however, there were continued to be periods of atony once the uterine massage was stopped. Bedside istat demonstrated H/H 11.5/35.5. Cervix was inspected again at this time. An anterior cervical laceration was noted to be contributing to blood loss. Lidocaine was injected to the cervix. This was repaired with 3-0 vicryl rapide in a running fashion. Dr. Jane Doe presented to bedside and assisted with cervical laceration repair. Additional bimanual sweeps were performed. Patient was given 3 bags of pitocin total after delivery. Additionally, another dose of methergine was administered. Uterine fundus and LUS was noted to be firm and vaginal bleeding had significantly slowed down. Perineum was observed for 20 minutes without additional intervention and hemostasis was appreciated. Patient is stable at this time. QBL: 1906 mL Continue to monitor vital signs closely (15 minutes). Repeat hemogram in the morning. Spent a total amount of 2 hours at bedside. Attending physician, Dr. Jane Doe, present for critical portions of procedure. Would CPT code 59300 qualify for this procedure or would I need to use the 12041-12047 or 13131-13133. Please advise. Thank you in advance!

 

[csperoni]

If the repair was performed by the same provider who is providing global maternity, it would be included in the global per ACOG. This would make a good case for -22 on the maternity care code.
NOTE: CPT does not consider the cervical laceration as part of the global maternity and states it may be coded separately.
So, if you are following CPT or the provider was not the one providing global maternity, then I would look at 57720 rather than laceration repair codes. 59300 does not seem appropriate as this was not a VAGINAL laceration, but rather a cervical one.
Here's a good article that includes a paragraph or 2 about cervical laceration. http://www.hcpro.com/content.cfm?content_id=305393

 

[dmarshall]

Thank you for the information provided as the care was not performed by the same provider providing global maternity, I appreciate your guidance to look at 57720.