Ob-Gyn Coding Alert

Question: If cervical ripening is included in the global fee, why is 59200 (insertion of cervical dilator [e.g., laminaria, prostaglandin] [separate procedure]) in the code book? When can we code this separately?

Kentucky Subscriber

Answer: The only time you can bill for Prostin gel insertion using 59200 is when it was inserted at least one day before delivery. This code is a separate procedure, meaning it is normally an integral part of the larger procedure. If you can document that the insertion took place at a different episode of care than the delivery (meaning the admission for delivery), you may be able to convince the payer to reimburse for the service. Most payers will not reimburse for it because the procedure was performed in the hospital, the dilator was used to ripen the cervix in preparation for induction and was inserted less than 24 hours prior to delivery. A physician who is not involved in the delivery could bill for the Prostin gel insertion without any problem.