How to Report Cervical Cerclage Procedure

Hello and welcome to our podcast series. My name is Meghann Drella and I’m a Senior Solutions Manager here at Outsource Strategies International (OSI). Today, I’ll be discussing how to report cervical cerclage procedures.

Regarded as a common medical procedure performed for cervical insufficiency or incompetence, cervical cerclage holds the cervix closed during pregnancy. Typically, the cervix is a narrow canal that connects the lower part of the uterus to the vagina of the woman and allows the baby to exit during birth. It is a funnel-shaped tissue from where the baby comes out of the uterus and through the vagina during childbirth. The procedure is recommended for women in order to prevent late miscarriage or pre-term or premature birth during pregnancy when the cervix starts to shorten or open too early. For a woman who has a history of one or more late miscarriages, it is advisable to undergo the treatment in the first or second trimester of pregnancy. The procedure is performed at the surgical center or at a hospital; the patient can go home on the same day after the procedure.

During pregnancy, a closed cervix helps keep the baby inside the uterus until delivery. However, as the pregnancy progresses, the extra pressure on the cervix may cause it to open before the baby is ready to be born. A cervical cerclage can help a pregnancy reach full term, at least 37 weeks, by keeping the cervix closed.

01:25 For Whom the Procedure is Done

Generally, cervical stitch is performed between 12 and 14 weeks of pregnancy and will remain in place up to the 24th week of your pregnancy until the risk of pregnancy loss or premature birth has passed. Physicians may remove the suture as the full-term due date approaches or if other indications arise. Cerclage may be done for women who are pregnant and have –

• Short cervical length
• Changes in the cervix during pregnancy
• A history of early pregnancy losses
• A history of inflammation or infection
• A history of surgery or trauma to the cervix and
• Structural abnormalities of the uterus

02:04 Risks Associated with the Procedure

Potential complications or risks associated with the procedure are very rare. But, all procedures have some amount of risk. Physicians will review potential problems like –

• Preterm premature rupture of membranes (PPROM)
• Premature labor or birth
• Infection of the cervix or amniotic sac that protects the baby
• Trauma to the cervix or nearby structures
• Inability of the cervix to dilate during normal labor
• Another cerclage for future pregnancies and
• Adverse reaction to anesthesia

02:35 Types of Cervical Cerclage

There are three different types of cervical cerclage – Transvaginal Cerclage, Transabdominal Cerclage and a McDonald Operation.

Before the procedure, the physician may perform a detailed physical examination which includes a manual pelvic exam to assess the cervix for abnormalities, such as flattening or opening. Other tests like blood tests and Transvaginal Ultrasound may also be performed to analyze the baby’s vital signs and rule out any major birth defects. In certain cases, the healthcare provider may take a swab of cervical secretions or do amniocentesis – a procedure in which a sample of amniotic fluid is removed from the uterus to check for infection.

Typically, cervical cerclage is performed as an outpatient procedure at a hospital or surgical center under regional or general anesthesia.

After cervical cerclage, an ultrasound is performed to check the baby’s well-being. Patients may experience some spotting, cramps and painful urination for a few days. Tylenol is recommended for managing pain or discomfort. If the physician used stitches to reposition vaginal tissue affected by incisions within the cervix, patients may notice passage of the material in two to three weeks as the stitches dissolve.

03:47 Billing and Coding for Cervical Cerclage

Billing and coding for cervical cerclage can be challenging, as it involves several rules related to reporting the procedure accurately. Physicians administering the cervical stitching must use the relevant CPT codes to bill for the procedure correctly. CPT codes include 57700 and 59325. Most women undergoing cervical cerclage can return home the same day after the procedure.

I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for joining me and stay tuned for my next podcast.