59409 and 59200

mrkianzky

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Id like to get opinions regarding this OB case, in which within a span of a few hours, Propess insertion was done, then followed by Vaginal Delivery (Vaginal Delivery only, no package). Owing to the fact that 59200 is a "separate procedure", is it safe to assume that 59200 is billable with a modifier 59, given they were done in succession? There is an NCCI edit for these 2. I don't know exactly if that affects the coding, or if they can still be treated separately regardless of the time interval. Or do you think we can go without coding 59200? I don't if this makes any sense, this sounds more organized inside my head. LOL
 

khines80

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CPT 59200 same day as delivery

The Coding Blast website indicates that services included in the Global Obstetrical Package include insertion of cervical dilator on same date as delivery (CPT code 59200). In your case, since it was on the same day you could not separately bill for the cervical dilator.

http://codingedge.blogspot.com/2015/06/obstetric-and-gynecology-care-coding.html

NCCI Coding Guidelines indicate the same, that CPT 59200 with a delivery code is not separately paid and a modifier is not appropriate with this code combination.

I would say in your scenario, CPT 59200 is not billable even with a modifier.

I hope this helps,
Kendra
 
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