Ob-Gyn Coding Alert

Question: My ob-gyn delivers patient vaginally and does an episiotomy repair in the room. Afterward, the patient goes to the OR for a vaginal laceration repair by the same physician that delivered her baby. What procedure code could I bill? Code 59300?

California Subscriber

Answer: No. The delivering ob-gyn can never bill 59300 (Episiotomy or vaginal repair, by other than attending physician), because this procedure is an integral part of the services payers include with every delivery.

Besides, payers will not reimburse for repair of 1st or 2nd degree lacerations, but some will pay for repair of welldocumented 3rd and 4th degree lacerations. If you want to get paid, you will need to use the integumentary repair codes by size and type (simple, intermediate or complex). For instance, you would report 12001-12007 for simple repair, 12071-12047 for intermediate repair, and 13131-13132 for complex repair.

Another option is to add modifier 22 (Increased procedural service) to the code you reported for the delivery/maternity care (such as, 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) -- but only if the documentation supports significant additional work over and above a normal episiotomy repair.