Wiki Bill Cercalge removal same day as delivery?

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sfirth1

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Patient went into labor and had her cervical cerclage removed prior to her vaginal delivery. Billed 59400-UC and 59871-51. Peach State denied 59871 stating" reimbursement included in another code." This shouldn't been globaled due to separate procedure and not part of routine OB care. Anyone have luck in getting payment? Suggestion?
 
Was it done under general anesthesia? If not, it is usually included in the delivery.

Here is a common coverage policy:

The following services are considered an integral part of a vaginal delivery (59400-59410) or a cesarean section (59510-59515), or delivery after previous cesarean delivery (59610-59622). They are not eligible as distinct and separate services. Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines.​
  1. Induction of labor (e.g., PEGGELL insertion, use of pitocin)
  2. Augmentation of labor (e.g., use of pitocin)
  3. Removal of cervical cerclage sutures prior to delivery under local anesthesia or without anesthesia. NOTE:Separate payment may be made for the removal of cerclage suture under anesthesia (other than local) (59871)
    Methods used to alter presentation of the fetus such as internal rotation, use of forceps, etc. NOTE:Separate payment may be made for external version (59412).
  4. Suturing of episiotomy
  5. Fetal scalp blood sampling (59030)
  6. Fetal monitoring
 
SharonCollachi said:
Was it done under general anesthesia? If not, it is usually included in the delivery.

Here is a common coverage policy:

The following services are considered an integral part of a vaginal delivery (59400-59410) or a cesarean section (59510-59515), or delivery after previous cesarean delivery (59610-59622). They are not eligible as distinct and separate services. Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines.​
  1. Induction of labor (e.g., PEGGELL insertion, use of pitocin)
  2. Augmentation of labor (e.g., use of pitocin)
  3. Removal of cervical cerclage sutures prior to delivery under local anesthesia or without anesthesia. NOTE:Separate payment may be made for the removal of cerclage suture under anesthesia (other than local) (59871)
    Methods used to alter presentation of the fetus such as internal rotation, use of forceps, etc. NOTE:Separate payment may be made for external version (59412).
  4. Suturing of episiotomy
  5. Fetal scalp blood sampling (59030)
  6. Fetal monitoring
Click to expand...
Patient had cerclage removed in OR due to unsuccessful attempt due to widening. She was given an epidural. I did modifier 51 so I'll resubmit w/ modifier 59 and see if that work with medical records attached to claim. Thanks for your help.
 
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