Wiki Repair following home delivery/different provider

[TinaG]

I have been out of OB/GYN coding for awhile and i have a case hoping for some assistance with the codes
Patient has 3rd degree tear following a home delivery by a midwife, came to ER and surgeon repaired
Rt & Lt vaginal sulcus tears, perineal repairs, anal sphincter repair and repair labia minora.
The surgeon and the midwife are not part of the same group.

Thank you

 

[csperoni]

I would consider this 59300 Episiotomy or vaginal repair, by other than attending
If the physician repairing was the attending, then 1st & 2nd degree repairs are included in delivery. 3rd & 4th degree are payable. Some will recommend to add modifier -22 to delivery. Some will recommend 12041—12047 for intermediate or 13131—13133 for complex.

I like to provide references for my answers and I KNOW I've seen an ACOG article about it, but they must have revamped their website and my saved tabs are no longer valid. I'm sure if you poke around on there you can find it.

 

[nielynco]

I would consider this 59300 Episiotomy or vaginal repair, by other than attending
If the physician repairing was the attending, then 1st & 2nd degree repairs are included in delivery. 3rd & 4th degree are payable. Some will recommend to add modifier -22 to delivery. Some will recommend 12041—12047 for intermediate or 13131—13133 for complex.

I like to provide references for my answers and I KNOW I've seen an ACOG article about it, but they must have revamped their website and my saved tabs are no longer valid. I'm sure if you poke around on there you can find it.

Yes, they have revamped their website. Published coding questions can now be found at: https://www.acog.org/practice-management/coding/coding-library#f:@selectedcontenttype=[Coding FAQ]. You can also ask them a question via this site as well, but I believe you still have to be a member (or staff person of a member) to do so. But I agree with your response. 59300 (4.33 RVUs in facility setting) was intended to be used for repair by a provider who did not do the delivery (or was not a member of that practice). The RUVs in this setting for 12041-12047 (and require measurements) would be 4.21 to 10.51, and for the complex repair codes 13131-13133 (which would also require documentation of debridement) 7.06-8.83 RVUs (plus 3.65 RVUs for each additional 5 cm of repair with 13133). My guess is that the payer will prefer 59300 since this is directly delivery related.