If the same physician removing the cerclage suture also performed the cerclage, he or she cannot charge for the removal. The removal is included in the insertion. If the physician removing the cerclage did not perform the procedure, you can only code this service as an E/M service. You would not report 59899 (unlisted procedure, maternity care and delivery) because you are not performing a surgical procedure when you remove sutures. You can also bill for the local anesthetic if a block was used 64430 for a pudendal block or 64435 for a paracervical block
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