Wiki Episiotomy breakdown CPT code assistance

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dmarshall

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Hello OB/GYN Group,

This is a new patient seen in the clinic and delivered approximately 3 months ago by another physician who is not in our group, however she sustained an episiotomy during her delivery that was not repaired and is now experiencing dyspareunia.
Our physician says she was told she had no tear which was obviously wrong. Her tear just healed and almost totally closed her introitus, please see the procedure note below:

Procedure: Skin was cleansed with betadine. Skin was infiltrated with 1% lidocaine. Vaginal stricture opened with scalpel down to the level of the defect. Vaginal incision was closed in a two step technique. Midline defect repaired with 3-o vicryl in usual running fashion to the level of the hymen. The perineal incision was closed parallel to the introitus with a running stitch of 3-0 vicryl to prevent future strictures with healing . Patient tolerated well. Strict pelvic rest and lifting precautions given for 6 weeks.

I know I cannot use 59300 or 56810, so I was leaning towards using the integumentary repair codes based on the type of repair (simple [12001-12007], intermediate [12041-12047], or complex [13131-13132]), and as she appears to be out of the global period. Would this capture all the work performed? Please advise.

Thank you so much for helping me!
 
dmarshall said:
Hello OB/GYN Group,

This is a new patient seen in the clinic and delivered approximately 3 months ago by another physician who is not in our group, however she sustained an episiotomy during her delivery that was not repaired and is now experiencing dyspareunia.
Our physician says she was told she had no tear which was obviously wrong. Her tear just healed and almost totally closed her introitus, please see the procedure note below:

Procedure: Skin was cleansed with betadine. Skin was infiltrated with 1% lidocaine. Vaginal stricture opened with scalpel down to the level of the defect. Vaginal incision was closed in a two step technique. Midline defect repaired with 3-o vicryl in usual running fashion to the level of the hymen. The perineal incision was closed parallel to the introitus with a running stitch of 3-0 vicryl to prevent future strictures with healing . Patient tolerated well. Strict pelvic rest and lifting precautions given for 6 weeks.

I know I cannot use 59300 or 56810, so I was leaning towards using the integumentary repair codes based on the type of repair (simple [12001-12007], intermediate [12041-12047], or complex [13131-13132]), and as she appears to be out of the global period. Would this capture all the work performed? Please advise.

Thank you so much for helping me!
Click to expand...
In order to use 12041-12047 you will have to have the length documented; if not, AMA coding advice is to then report the lowest level code. What is described is an intermediate, not a complex repair. Some payers may accept 59300 if your provider has absolutely no affiliation with the one who provided the maternity care, but the relative value for this code is lower than those for 12041-12047.
 
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