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Ob-Gyn Coding Alert

Reader Question :
Charge for Additional Surgery During C-Section

Question: During a cesarean section, my ob-gyn repaired the rectus abdominus muscles. Is this included in the c-section, or is there a separate code for this? Washington Subscriber Answer: If the repair involved significant additional work, you should add modifier -22 (Unusual procedural services) to the cesarean section code (59510, Routine obstetric care including antepartum care, cesarean delivery, and postpartum care; 59514, Cesarean delivery only; and/or 59515, including postpartum care). CPT does not contain a code that specifically addresses this type of repair, and the cesarean code normally does not involve repairing this separated muscle. But this condition can occur with any pregnancy due to the weight of the uterus pulling downward on this muscle group. Usually, the ob-gyn gives the pregnant patient exercises to perform to help prevent this problem. If the surgeon repaired this condition during a separate session after the birth, most payers would consider it an abdominoplasty (15831, Excision, excessive skin and subcutaneous tissue [including lipectomy]; abdomen [abdominoplasty]) and would not cover the procedure.  

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