Ob-Gyn Coding Alert

Question: My ob-gyn prescribed Cytotec vaginal suppositories after he determined the patient had a spontaneous incomplete abortion with no surgical intervention. How should I code this?

Massachusetts Subscriber

Answer: First things first — you should examine what transpired. That will definitively tell you how you should report this service. Here are three options:

1. If the physician only gives the patient a prescription to obtain and self-insert the Cytotec, you cannot bill this service.
2. On the other hand, if the ob-gyn sees and evaluates the patient and then gives the prescription, you should report this visit as an E/M service (99201-99205 for new patients, or 99211-99215 for established patients).
3. If the ob-gyn inserted the Cytotec vaginal suppositories, you should report 59200 (Insertion of cervical dilator [e.g., laminaria, prostaglandin] [separate procedure]).

Caveat: You’ll submit 59200 instead of or in addition to an E/M service, depending on what your ob-gyn documents at the time of the encounter. And if you bill it in addition, don’t forget to add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M service.