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Carla Posted Mon 15th of January, 2018 12:26:32 PM
How do I bill for Vaginal bleeding and repair of vaginal laceration 3 days after delivery? I bill for CRNA's who performed the anesthesia. My claim was rejected saying the code I used was incorrect. I have the procedure code as 00940 (repair of vaginal laceration) I believe that procedure code is correct. Any thoughts on the DX code and if my procedure code is correct? Thank you in advance for your help.
SuperCoder Answered Tue 16th of January, 2018 03:07:27 AM

Hi,

The diagnosis code will depend on the CPT code used by the physician.

This seems to be a tricky scenario. 

As per ACOG, the services of the CPT code (repair) would be included in the global CPT code (Delivery code). Repair of first and second-degree lacerations are not to be reported separately. However, third and fourth degree lacerations extending beyond the perineum into areas such as the rectum and anus can be billed as separate services. Since these repairs require significant additional physician work, they are separately reportable.    

Your documentation should be strong enough to suggest that laceration was not caused due to episiotomy. The reason for post-partum bleeding should be other than episiotomy. If your documentation suggests that, then you should use the appropriate ICD 10 code as per your documentation.

If this is the scenario (above paragraph), then O72.2 should be used as the diagnosis code. Also, let us know the diagnosis code you are using. It will help us identify the appropriate anesthesia CPT code.

Let us know your thoughts!

       

 

 

Carla Posted Tue 16th of January, 2018 12:30:27 PM
Thank you. I had used the code O72.2. I will check with the provider and get more information. Carla
Carla Posted Tue 16th of January, 2018 12:52:21 PM
Hi Again, Just spoke to the OB provider's coder and biller. They were paid. Here are the codes they used: O722 Delayed post partum & 2ndary hemorrhage& O717 Obstetric hemorrhage and they used 50722 I&D Vaginal Hematoma Repair for procedure. I really don't know what code I should have used now. I am assuming 00940, repair of vaginal laceration would be correct for the procedure code but have no idea what code to use for anesthesia DX. Obviously vaginal bleeding is not supportive enough. Thank you for your help with this. SINCERELY, Carla
SuperCoder Answered Wed 17th of January, 2018 05:51:13 AM

Hi,

 

As per the federal body, appropriate anesthesia code for CPT code 57022 (incision and drainage of vaginal hematoma; obstetrical/postpartum) would be 00940.

 

There are chances that you might be lacking the appropriate modifier usage with CPT code 00940.

 

Append appropriate modifier for CRNA service(s)- QX, QY, QZ (based upon your documentation) with anesthesia code 00940.

 

ICD code(s) appended by the provider are appropriate. i.e., O72.2, O71.7

Note: Kindly check with your payer for reimbursement guidelines. There are chances that you might be billing inappropriate coding combinations as per your Local Coverage determination (LCD).

 

Thank you.

Carla Posted Wed 17th of January, 2018 11:51:31 AM
Awesome! thank you for all your help. Carla
SuperCoder Answered Wed 17th of January, 2018 23:57:18 PM

Your welcome!

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