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4th degree laceration with delivery

Misty Posted Wed 20th of July, 2016 18:13:20 PM
I just need to confirm about billing severe lacerations with delivery for my provider. I have read other post answers but I am still not sure. My provider was in the OP room 3 hrs after initial delivery to repair. My provider delivery op notes read: The patient pushed for an hour. Patient did not want episiotomy. Perineal body was being stretched out with pushing before delivery of baby. The perineum weakened above the rectal sphincter and meconium was coming out of this. With next push there was more tearing so told patient I was going to cut the episiotomy to complete connection to the skin that was already dehiscing. Baby then delivered. Since no epidural was done and the repair that was required was so extensive we went up to the OR. The extent of her lacerations included bilateral sulcal lacerations as well as she avulsed the hymenal ring off of the left, and there was just 1 small connection there to her remainder of the hymenal ring. She had a 4th degree lac and nearly avulsed off the skin of the anus. This lac also seemed to extend into the perirectal space. So because of this, OR anesthetic needed and to close this extensive lac. I reapproximated the sulcal lac with 3-0 vicryl up until about the hymenal ring what was left of it. At this point, I went ahead to repair the 4th degree lac. It did not extend too far on the rectal mucosa but I did 2 layer interrupted sutures of 4-0 over this, imbricating the second layer. We saw separation into the perirectal space and per consult with another physician asked if he felt that any type of drains were needed, he felt none needed. At this point I went ahead and repaired rectal sphincter, then I placed several sutures to reapproximate the muscles over the perineal body. I then finished off the rest of the repair as a routine 2nd degree starting with the vaginal mucosa, running this to the hymenal ring and then tucked this under and brought it out under the hymenal ring and finished up with the 3-0 to closed the skin incision. I then placed a couple of interrupted 4-0 vicryls around the skin of the ring of tissue that was left by the anal opening. Procedure complete. Would there be an extensive lac repair cpt code I can bill with modifier besides just adding modifier 22 to delivery code? Any help would be greatly appreciated. Thanks
SuperCoder Answered Thu 21st of July, 2016 08:41:33 AM
Repairs of lacerations after birth are generally considered part of the delivery service, but sometimes a case can be made to bill for the repair if it is at least a third-degree or fourth-degree laceration. Unfortunately, there are no CPT codes for this repair, other than the code for episiotomy, a procedure that is included in the global service. Therefore, if the repair of the laceration was extensive, you can add modifier -22 (unusual procedural services) to the delivery or global code, or you can bill for it separately using the complex repair codes 13131-13133 (but the length of the wound repaired must be known). These are the closest codes that describe such a repair of the genitalia.In this case, because the patient was taken back to the OR for the procedure, you need to add modifier -78 (return to the operating room for a related procedure during the postoperative period) to the repair code. Use CPT 13131 for laceration 1.1 cm to 2.5 cm; 13132 for 2.6 cm to 7.5 cm; and 13133 for each additional 5 cm or less. Please find below SuperCoder link for better understanding https://www.supercoder.com/my-ask-an-expert/topic/3rd4th-degree-laceration-repair-documentation

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