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Episiotomy repair

  1. #1
    Location
    Madison Wisconsin
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    50
    Question Episiotomy repair
    Exam Training Packages
    If we have a Family practice provider that performed the delivery on a pt then requested the OB-Gyn provider repair the 3rd degree laceration (the global package was broke apart due to insurance change mid pregnancy) both belong to our organization how would I bill this?
    Gina, CPC

  2. Default
    Third degree Repair would not meet to be included as a part in the Delivery code as does the conventional episiotomy. It invloves the rectal mucosa and/or the anal sphincter repair, which goes for complex Repair; this code would belong to the OBGYN separately ( from the delivery code) with E/M for consult billed under his/her name, if there was a request from the Physician for OB consultation.
    The family physician will get the Delivery code as Delivery and postportum care, or the global whichever is appropriate depending upon the prenatal visits care provided by her.

    [The perineal lacerations are classified like this: first degree tear—a perineal laceration extending through the vaginal mucosa and perineal skin only;
    second degree tear—laceration extending into the perineal muscles;
    third degree tear—laceration involving the external anal sphincter; plus the above
    fourth degree tear—laceration affecting both the anal sphincter and the anorectal mucosa. plus the above ]

    Basically the tissues involved in the second degree tear simulate those involved in the regular (Medilateral) episiotomy wound, meaning upto that can be included into the normal delivery code(just as episiotomy is included).
    The third degree and the forth degree definitely meets the complex/extensive repair.

    .................................................. .....

    As regards the split in the global,have a look at this long passage and find out any one example would suit/help yours for global/ split visits: From UW Physician -OBGYN Coding:

    [b]Splitting the Global Package[/B
    ]Maternity care and delivery should be billed as a single code except when certain circumstances occur that require the package to be broken including the following:
    • The patient has a change of insurer during her pregnancy
    • The patient has received part of her antenatal care somewhere else (including transfers of care from UWP Family Medicine to UWP Obstetrics and Gynecology)
    • The patient leaves her care before the service is complete
    • The documentation requirements for global billing (above) have not been met
    Antenatal DocumentationWhen a patient receives antenatal care from a UWP provider and the care is not part of a global delivery package (as above), antenatal care must be coded separately. These services may be billed alone or in conjunction with Evaluation and Management (E/M) codes, delivery codes, postpartum codes and other service codes.
    The Antepartum care only codes are used when 4 – 6 visits (59425) or 7 or more visits (59426) have been provided and will be billed to the same insurer but the global delivery code cannot be billed (see above) and a UWP provider in the same specialty has also performed the delivery.
    Example
    • A patient presents to the General OB Clinic for obstetrical care in the 8th week of her pregnancy. She is seen monthly for the first 28 weeks, biweekly to 36 weeks and weekly until her delivery at 39 weeks for a total of 13 visits. In her 21st week she has a change of insurance. The first four visits will be billed to her first insurer with code 59425. The additional 9 visits will be billed to her second insurer with code 59426. The delivery and postpartum care code will be billed separately to the second insurer as well.
    The Antepartum care only codes are used when 4 – 6 visits (59425) or 7 or more visits (59426) have been provided and will be billed to the same insurer and a UWP provider in the same specialty has not performed the delivery.
    Examples
    • A patient is managed by a facility-employed midwife for 3 visits before the decision is made to transfer her care to an obstetrician due to her history of cesarean delivery. She presents to the General OB Clinic for obstetrical care in the 20th week of her pregnancy. She is seen nine times prior to her scheduled cesarean delivery. The antenatal visits will be billed to her insurer with code 59426. The cesarean delivery and postpartum care will be billed separately.
    • A patient presents to the General OB Clinic for obstetrical care in the 8th week of her pregnancy. She is seen five times prior to moving out of state and changing providers. These visits will be billed to her insurer with code 59425.
    The Antepartum care only codes are used when 4 – 6 visits (59425) or 7 or more visits (59426) have been provided and will be billed to the same insurer but the package must be broken because of a physician presence or documentation issue.
    Example
    • A patient presents to the General OB Clinic for obstetrical care in the 8th week of her pregnancy. She is seen monthly for the first 28 weeks, biweekly to 36 weeks and weekly until her delivery at 39 weeks for a total of 13 visits. The patient's uncomplicated delivery is handled by a resident while the TP is performing a cesarean section for another patient. The antepartum care will be billed to her insurer with code 59426. Postpartum care will also be billed, if appropriate. The delivery will not be billed.
    When fewer than 4 visits are to be billed to an insurer these services are billed using E/M Codes. E/M codes may also be used to bill for extra visits for complicated antenatal care or care unrelated to the pregnancy (see below). Each visit is billed with a separate code. See the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services and the UWP Guidance on E/M Gray Areas for further information on determining which code(s) to use for these services. The Teaching Physician must personally document his or her own presence and participation for each visit to be billed with an E/M code.
    Example
    • A patient presents to the General OB Clinic for obstetrical care in the 8th week of her pregnancy. She is seen monthly for the first 28 weeks, biweekly to 36 weeks and weekly until her delivery at 39 weeks for a total of 13 visits. In her 14th week she has a change of insurance. The first two visits will be billed to her first insurer as E/M codes. The additional 11 visits will be billed to her second insurer with code 59426. The delivery and postpartum care code will be billed separately to the second insurer as well.
    When Patients Have Received Antenatal Care Elsewhere, global billing is not appropriate and the services provided by UWP providers must be unbundled. A single visit for evaluation to confirm a pregnancy is not considered prior antenatal care.
    The following sources will substantiate prior antenatal care:
    • The patient's previous antenatal medical records,
    • Contact with the patient's previous provider, or
    • The patient provides information about previous antenatal care, such as the name of previous provider, name of previous care site, number of previous visits, or description of prior antenatal care received.
    If the provider does not have information from one of these sources, he or she will assume that he or she is providing all antenatal care.
    -

  3. Default
    664.24 Third-degree perineal laceration, postpartum condition
    59300 Episiotomy or vaginal repair, by other than attending physician

    Hope this helps.


    ~Kelli S.

  4. Default
    PS: I have also seen physicians use the repair codes for perineal lacerations:

    664.24 Third-degree perineal laceration, postpartum condition
    13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet.


    ~Kelli

  5. Default
    This particular scenario presented to us needed a consult / OBGYN Service to mend the 3rd degree (or 4th degree ) tear, which should basically be provided by OBSTETRICIAN (CONSULT) on request. 59300 does not meet the requirements as for 3rd or 4th degree tear; that is why I said the Repair-Complex code, is to be reported by the OBGYN.
    Thank you

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