Coding Question of the Month: November 2019

Billing for Misoprostol 

QUESTION: I was treating my patient in the hospital for two days with misoprostol to ripen the cervix because she was post-date. Can I bill for this service?

ANSWER:

The Maternity Care and Delivery section guidelines in CPT states: “Medical complications of pregnancy (eg, cardiac problems, neurological problems, diabetes, hypertension, toxemia, hyperemesis, preterm labor, premature rupture of membranes, trauma) and medical problems complicating labor and delivery management may require additional resources and may be reported separately.”

You can bill CPT code 59200, Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure), to report the placement of misoprostol for cervical dilation or ripening. The lay description for this code states that CPT code 59200 is to be used to report chemical stimulation and dilation of the cervical canal.

If this service was performed one day or more prior to delivery, it can be reported separately.

If this service was performed on the same day as a delivery, it is considered part of the global obstetric package and not reported separately.

Billing for the service is the same for both inpatient and outpatient settings. However, payer policies vary. Please contact your payer regarding their billing policies. It is advisable to get their response in writing.

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American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188
Mailing Address: PO Box 96920, Washington, DC 20024-9998