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Ob-Gyn Coding Alert

You Be the Coder:

Delivery Includes Episiotomy Repair

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Can I bill for episiotomy repair if the attending physician did the repair and delivery, or can I only bill for the delivery? Ohio Subscriber  

Answer: No, the delivery includes the episiotomy repair. If the repair is extensive, however, you have a case for adding modifier -22 (Unusual procedural services) to the delivery code (59400, 59409-59414). For example, if the episiotomy results in a third-degree laceration, you could report 59400-22 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). As with any modifier -22 claim, you should attach a letter stating exactly what made the procedure unusual, including the extenuating circumstances and the extra work and time involved.

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