Wiki Postpartum Vaginal Laceration Repair

breyes

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Coding help please. This is a completely new situation for me: I have a CNM that billed out for a 59400. An OB (not part of our group) performed a repair at the time of delivery. 8 Days post-partum, the patient was seen in our office by the delivering CNM. CNM notes: "Vagina - 2 cm reopening of vaginal tear @ introitus extending approximately 3 cm deep into vaginal vault. Two areas of suture visible. Site of reopening has increased bleeding." Treatment: "Vaginal Lac was repaired w/2.0 in the usual fashion" I think I have a couple issues. Currently, the provider has this DX as O70.1. I am thinking that we will need to include some sort of postprocedural complication dx. Regarding the actual repair - I'm pretty sure this is billable even though she was the delivering provider (but not positive). Do I look at laceration repairs (12001) or do I look at 59300? I'm also looking at modifiers. This was an unplanned procedure during the global period. Would 78 be appropriate (procedure room in clinic not hospital OR). So many questions on this one. I look forward to your input.
 
I would call this a complication of wound dehiscence and this led me to 12020 with the tear in a mucous membrane that is easily accessed. And mod 78 to report unplanned seems appropriate given the complication of wound dehisence.
And the fact that the CNM didn't perform the original repair in my mind is to the CNM's favor. But was the repair done as a "professional courtesy" or was it recorded in the delivery record? If it's in the docuemented in the record, the chances of this being paid is much better than if it wasn't.
Wow! My brain is spinning around and around on this one!

Argh! I can't stop ruminating about this!! Don't forget to add the 25 Modifier to an E/M since this is not part of global fee!
One more thing: O70.1 is not right for this instance since the wound was already addressed at delivery. I believe O90.1 is more suitable and I don't know how to document the extra bleeding.
Ok I'm done. ;)
 
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