Karen Posted Tue 25th of September, 2012 20:56:56 PM
'Our patient is post cesarean section, < 24hrs after delivery and begins to hemorrhage. The doctor returns her to the operating room and a Bakri Balloon was used for treatment. Is this separately billable or included in PP care? If so, my guess would be CPT 59899, -78 modifier, ICD-9 666.12.'
SuperCoder Answered Tue 25th of September, 2012 23:53:47 PM
According to the appropriate coding authorities, “59899 – unlisted procedure, maternity care and delivery” should be reported for placement of this device. If curettage is performed to control postpartum uterine bleeding, then CPT code “59160 – curettage, postpartum” should be reported along with 59899 for placement of the tamponade balloon.Submission of claims with unlisted codes typically requires:
(a) a paper claim;
(b) a procedural note attached to the claim; and (c) a cover letter to the health plan/payer which contains the following information: 1) identification of comparable procedure(s) to assist the insurer in establishing a payment level;and 2) an explanation of the procedure, the patient selection, the medical necessity and clinical benefits.
The possibility exists that some payers would consider placement of the Bakri Postpartum Balloon to be included in the postpartum package, and therefore not reported separately from your usual obstetrical coding [see “Obstetrical Procedural Coding” below]. Therefore, we encourage you to contact your local payers on this coding issue.
Karen Posted Fri 28th of September, 2012 23:16:42 PM