Ob-Gyn Coding Alert

You Be the Coder:

Code This Fetal Demise Scenario

Question: I need to ask for assistance or advice on a charge that an ob doctor has dropped. The op report states, REPEAT LOW TRANSVERSE CESAREAN SECTION, BILATERAL SALPINGECTOMY, RIGHT OVARIAN CYSTECTOMY. The patient was 36 weeks and had fetal demise.

The charges that the physician is dropping are:

-59618 PR ROUT OB CARE,C-SEC,PREV C-SEC linked to O36.4XX0 (Maternal care for intrauterine death, not applicable or unspecified)

-58700 PR REMOVAL OF FALLOPIAN TUBE linked to Z30.2 (Encounter for sterilization)

-58925 PR REMOVAL OF OVARIAN CYST(S) linked to D27.0 (Right dermoid cyst)

Is 59618 billable? The patient has a commercial plan and was under global ob care with physician. Shouldn’t we report C-section code 59510? For the tubal ligation bilateral per op report, shouldn’t the code be +58611? I agree with 58925, as patient did have removal of right cyst.

Any help would be appreciated!

Texas Subscriber

Answer: If this physician or this physician’s group provided all of her ob care and this was a VBAC delivery (i.e., she was allowed to labor before the decision was made that they had to repeat the cesarean), the correct code would be 59618 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery). If this was simply a planned repeat cesarean, the global code would be 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care), not 59618. You will have to look at the delivery notes to be sure.

Regarding the bilateral salpingectomy for sterilization, the correct code for salpingectomy for sterilization at the time of C-Section is +58611 (Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure)), not 58700 (Salpingectomy, complete or partial, unilateral or bilateral (separate procedure))—even though the ob-gyn is removing the tube, not ligating/transecting.

Code 58925 (Ovarian cystectomy, unilateral or bilateral) is correct for the right ovarian cystectomy.