Global Delivery & Post Partum care

bonnyr

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I'm trying to find documentation as what is & is not included in the global code 59410. My provider did the delivery and also repaired a 3rd degree laceration. The insurance denied CPT 12041 with modifier 51 as included in the global. I've been told before that 3rd & 4th degree lac's are billable separately. Does anyone have any specific literature I could reference for my appeal?
Thanks,
Bonny
 

preserene

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Yes as such with the available codes , the payers are correct to incorporate the laceration procedure into the global code 59410
59410- For vaginal Delivery and postpartum care, with or without episiotomy and /OR forceps. This statement clearly describes that it includes episiotomy,forceps.
EPISIOTOMY means clean incisional cut made on the perineum including the layers of the vagina.
But in your case, it is laceration 3-4th degree.
I do not find any CPT OBSTETRICAL code separately for 3rd degree or 4th/complete perineal tear (obstetrical). There are codes for nonobstetrical. You would not be allowed to go for 12041, because in 3-4th degree all the layers of vagina and mucosa of rectum and anal sphincter (4th degree) are involved, additionally it is an obstetrical injury.

You can append -22 and support with the diagnosis codes for the 3-4th degree perineal laceration/Tear. 664.x series .depending upon the tissues involved.

I too feel as with available codes , 59410 includes all degrees of tear just sharing with/ without the episiotomy /or forceps.
Well whenn forceps application and delivery is incorporated inthis code, well, it is fair enough that laceration degrees are also included in this global code
 
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REPAIR OF LACERATIONS FOLLOWING DELIVERY


Can I report separately for the repair of lacerations following delivery?

ACOG's position is that the repair of first and second degree lacerations are not to be reported separately. However, third and fourth degree lacerations extend beyond the perineum into areas such as the rectum and anus. Since these repairs require significant additional physician work, they are separately reportable.

ACOG's Coding Committee recommends the following two options for reporting complete third and fourth degree lacerations repair:

Option 1:
Append the modifier 22 (increased procedural services) to the appropriate delivery or global package code. Documentation describing the extent of the injury should be submitted with the claim.

Option 2:
Depending on whether the repair is intermediate or complex, the physician can report a CPT-4 code from the Integumentary series, 12041—12047 (repair intermediate) or 13131—13133 (repair complex). The appropriate repair code would be reported in addition to the delivery or global package code.

Note: If the physician who performs these repairs is not the physician who delivered the baby report CPT-4 code 59300 (Episiotomy or vaginal repair, by other than attending physician) instead.


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LOVETAMBRA

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Episiotomy repair

I have been paid for global delivery with the episiotomy repair, but it depends on the insurance and I think the person that is processing your claim. Here is how I bill it to get paid.

59400--AG GLOBAL
59300-59 WITH DX 664.01
of course diagnosis is for this particular claim.
 
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Patient delivers on the way to the hospital and the CNM only does laceration repair and placenta removal. Would I still code cpt 59400 or 59300 and 59414?
 
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