Ob-Gyn Coding Alert

Question: Is there a code for operative vaginal delivery with forceps and vacuum? My hospital has been billing for a global standard vaginal delivery fee, regardless of the delivery mode. However, they bill a higher rate for vaginal birth after cesarean (VBAC) 59610-59614. Is there a way to notify the insurance carriers of an increased risk and increased liability for these procedures and therefore obtain better reimbursement compared to vaginal delivery?

Charles Deborah, MD
Mason City, Iowa

Answer: The definition of maternity services in CPT 2001 (page 201 of the professional edition) states that vaginal delivery includes episiotomy and forceps (if used). The American College of Obstetricians and Gynecologists in its coding manual Components of Correct Procedural Coding has indicated that vacuum extraction is also included as part of the service and should not be coded out separately. VBAC has its own specific CPT code because the service requires more intense physician work routinely. If a physician believes that the use of forceps or vacuum extraction for a particular patient was significantly more work than is usually the case and this significant additional work has been documented, you always have the option of billing the insurance company for the global service using modifier -22 for unusual procedural services. You would of course need to send in the documentation with the claim.


- Answers to "You Be the Coder" and "Reader Questions" were provided by Melanie Witt, RN, CPC, MA, an ob/gyn coding expert and independent coding educator in Fredericksburg, Va.