Wiki Post C/S hysterotomy repair

[debellis59]

Hi Everyone:

I need some advice here. I thought I had posted this already, but don't find that I did. Hmmm.

Anyway, one of our patients delivered by C/S and a midwife was the assistant. Unfortunately, there ended up being bleeding leading to inadequate visualization that made repairing the hysterotomy difficult, so another MD (not part of our group) was called in to help with the hysterotomy repair. Primary states that "The apex could not be readily identified due to ongoing bleeding preventing adequate visualization."

The C/S is being coded as 59510-22, 59514-22, but not sure how to code for the other physician coming in to help with the hysterotomy repair. Yes, I am helping the other coder (for the other doctor) as she and I are both baffled on this one. Dr. Other couldn't be coded as an assist on the C/S as she wasn't there during the delivery, but she did help with the hysterotomy repair. This added a full 30 minutes to what should have been a normal C/S.

Any help you can provide would be huge.

Thank you,

Deb

 

[nielynco]

Hi Everyone:

I need some advice here. I thought I had posted this already, but don't find that I did. Hmmm.

Anyway, one of our patients delivered by C/S and a midwife was the assistant. Unfortunately, there ended up being bleeding leading to inadequate visualization that made repairing the hysterotomy difficult, so another MD (not part of our group) was called in to help with the hysterotomy repair. Primary states that "The apex could not be readily identified due to ongoing bleeding preventing adequate visualization."

The C/S is being coded as 59510-22, 59514-22, but not sure how to code for the other physician coming in to help with the hysterotomy repair. Yes, I am helping the other coder (for the other doctor) as she and I are both baffled on this one. Dr. Other couldn't be coded as an assist on the C/S as she wasn't there during the delivery, but she did help with the hysterotomy repair. This added a full 30 minutes to what should have been a normal C/S.

Any help you can provide would be huge.

Thank you,

Deb

So the other MD will absolutely want to bill for his assistance in which case I would code 59514-80-52 (since he was not in on the delivery). The nurse midwife will probably not get paid, but technically you could try billing 59514-80 (but I would not add a modifier -22 as the significant additional work took place after delivery, not during.

 

[csperoni]

I agree with billing as a C/S delivery only assist, but I would actually recommend 59514-81 for minimal assistant surgeon rather than -80-52 since as the additional MD was not present the entire time.
I would attempt billing the CNM as 59514-AS.
I will note this is an unusual case and receiving proper payment will likely be a struggle. I don't recall seeing a payor ever reimburse 2 different clinicians as an assist, even though the each assisted at different portions. Good luck!

 

[debellis59]

I agree with billing as a C/S delivery only assist, but I would actually recommend 59514-81 for minimal assistant surgeon rather than -80-52 since as the additional MD was not present the entire time.
I would attempt billing the CNM as 59514-AS.
I will note this is an unusual case and receiving proper payment will likely be a struggle. I don't recall seeing a payor ever reimburse 2 different clinicians as an assist, even though the each assisted at different portions. Good luck!

Thank you so much. This is a huge help. I've also not ever seen two assistants receive payment, but we'll try!

 

[debellis59]

So the other MD will absolutely want to bill for his assistance in which case I would code 59514-80-52 (since he was not in on the delivery). The nurse midwife will probably not get paid, but technically you could try billing 59514-80 (but I would not add a modifier -22 as the significant additional work took place after delivery, not during.

Your help is very much appreciated. Thank you and yeah, definitely a new one on me.