C-section leading to postpartum hemorrhage and uterine artery ligation
A uterine artery ligation with a B-Lynch suture is not typically a billable service during C-section because hemostasis is part of any surgical procedure. If the work associated with securing hemostasis was very complicated and substantially greater than typically required, some payers may accept the use of modifier “22” on the delivery code for additional reimbursement. The documentation should reflect the difficulty and the additional work associated with the use of this modifier, in addition to the additional time necessary for it (time alone is not enough). It is advised to check with your local payers for their preferred method of reporting these services. However, if there was postoperative intensive care and extra hospital days involved due to complications, it would be appropriate to code for these services outside of the global obstetric package.
22 Increased Procedural Services: When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service.