How To Use CPT Code 59320

CPT 59320 describes the procedure for cerclage of the cervix during pregnancy, specifically performed vaginally. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 59320?

CPT 59320 can be used to describe the surgical procedure of cerclage, which involves suturing the cervix closed to prevent premature dilation before a full-term delivery. This procedure is performed vaginally by a healthcare provider.

2. Official Description

The official description of CPT code 59320 is: ‘Cerclage of cervix, during pregnancy; vaginal.’

3. Procedure

1. The patient is positioned in the lithotomy position and given either a general or regional anesthetic.
2. The healthcare provider inserts a weighted speculum and cleanses the cervix.
3. If performing a McDonald cerclage, the provider grasps the anterior and posterior edges of the cervix with ring forceps and inserts a curved needle threaded with a thick nonabsorbable suture. The suture is passed four to six times in a purse-string manner around the entire cervix, avoiding the endocervical canal. The two ends of the suture are tied together and cut, leaving a long end for later removal. Bleeding is controlled, and instruments are removed.
4. If performing a Shirodkar cerclage, the provider inserts a Foley catheter to drain the bladder. The cervix is pulled forward with ring forceps while a surgical assistant stretches the vaginal sidewalls with a retractor. The provider makes incisions where the vaginal wall meets the cervix on both the front and back sides. The rectum and bladder are dissected off the cervix. Sutures or tape are placed around the internal os and tied off. If the patient will deliver by cesarean section, the knot is buried under the vaginal mucosa. Bleeding is checked, and instruments are removed.

4. Qualifying circumstances

CPT 59320 is performed on patients with an incompetent cervix, which refers to a weakness in the internal os that causes premature dilation. This procedure is typically done during pregnancy to prevent premature delivery. The patient must be positioned in the lithotomy position and receive anesthesia. The specific technique used, whether McDonald or Shirodkar, depends on the provider’s judgment and the patient’s condition.

5. When to use CPT code 59320

CPT code 59320 should be used when a healthcare provider performs a cerclage of the cervix during pregnancy using a vaginal approach. This code is appropriate for both the McDonald and Shirodkar techniques. It is important to note that CPT code 59320 should not be reported if the procedure is performed through an abdominal approach.

6. Documentation requirements

To support a claim for CPT 59320, the healthcare provider must document the following information:

• Patient’s diagnosis of an incompetent cervix
• Details of the specific cerclage technique used (McDonald or Shirodkar)
• Date of the procedure
• Start and end time of the procedure
• Positioning of the patient (lithotomy position)
• Type of anesthesia administered
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 59320, ensure that the procedure is performed vaginally and that the patient is in the lithotomy position. It is important to use the appropriate CPT code based on the specific cerclage technique used (McDonald or Shirodkar). If ultrasound guidance is used during the procedure, report CPT code 76998 in addition to CPT 59320. It is also crucial to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 59320 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs a vaginal cerclage using the McDonald technique for a patient diagnosed with an incompetent cervix during pregnancy.
2. Using the Shirodkar technique, a provider performs a vaginal cerclage on a patient with a history of premature delivery.
3. A pregnant patient with an incompetent cervix undergoes a vaginal cerclage procedure using the McDonald technique to prevent premature dilation.
4. A healthcare provider performs a vaginal cerclage using the Shirodkar technique for a patient at high risk for preterm labor.
5. Using the McDonald technique, a provider performs a vaginal cerclage on a pregnant patient with a history of cervical insufficiency.
6. A patient with an incompetent cervix during pregnancy undergoes a vaginal cerclage procedure using the Shirodkar technique to prevent premature delivery.
7. A healthcare provider performs a vaginal cerclage using the McDonald technique for a patient with a history of second-trimester miscarriages.
8. Using the Shirodkar technique, a provider performs a vaginal cerclage on a pregnant patient with a previous preterm birth.
9. A pregnant patient with an incompetent cervix undergoes a vaginal cerclage procedure using the McDonald technique to reduce the risk of premature labor.
10. A healthcare provider performs a vaginal cerclage using the Shirodkar technique for a patient with a history of cervical incompetence.