Ob-Gyn Coding Alert

Question: My ob-gyn performed a balloon for postpartum hemorrhage.Since the code I would use is the unlisted code 59899, I know I have to attach an op report. How should I price this using existing codes?

New York Subscriber

Answer: Your provider is going to have to help you with this. You must identify an existing CPT^® code that has a relative value unit(RVU) value that is equivalent to the work the ob-gyn performed.  For the Bakri balloon, you may want to look at the following codes for comparison:

• 43460 (6.65 RVUs) -- Esophagogastric tamponade, with balloon (Sengstaken type)
• 46604 (1.94 RVUs) -- Anoscopy; with dilation (e.g., balloon, guide wire, bougie)
• 51703 (2.41 RVUs) -- Insertion of temporary indwelling bladder catheter; complicated (e.g., altered anatomy, fractured catheter/balloon)
  

Another option is that if the balloon is placed before the patient is taken to recovery, add a modifier 22 (Increased procedural service)to the delivery code. But even when you use this option, you have to know by how much you need to increase your fee, and therefore, you still need to consult with the provider. Once you have identified a comparison code, you can check with your payer to see what they normally reimburse for it. But remember, that all payers will apply a fee reduction to additional procedures so do not expect to received that full value of the comparison code.