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The procedure described by CPT® Code 59200 involves the insertion of a cervical dilator, which can be a laminaria tent or prostaglandin, as a separate procedure. This intervention is utilized to assist in the process of cervical ripening, which is essential for preparing the cervix for delivery. During a typical labor process, the cervix undergoes a series of changes, including thinning, softening, relaxing, and opening, primarily driven by uterine contractions. However, in some cases, this natural process may not occur swiftly enough, necessitating the use of a cervical dilator to facilitate delivery. Various types of cervical dilators are commonly employed, including laminaria tents, prostaglandin gel, and prostaglandin mesh. Laminaria, derived from seaweed, is formed into a tube-shaped device known as a laminaria tent, which is inserted into the cervix. As the laminaria absorbs moisture, it expands, gradually dilating the cervical canal. Alternatively, prostaglandin can be administered in the form of a gel directly into the cervix or as a mesh placed in the vaginal vault. Prostaglandin serves as a powerful, hormone-like agent that not only softens the cervix but also stimulates uterine contractions, thereby aiding in the labor process.
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The insertion of a cervical dilator is indicated in specific situations where cervical ripening is necessary to facilitate delivery. The following conditions may warrant this procedure:
The procedure for the insertion of a cervical dilator involves several key steps that ensure the effective placement of the device. Each step is critical for achieving the desired outcome of cervical ripening.
Following the insertion of the cervical dilator, patients are typically monitored for a period to assess the effectiveness of the procedure and to ensure there are no adverse reactions. It is important to observe for any signs of labor onset, as well as any discomfort or complications that may arise. Patients may be advised on what to expect in terms of cervical changes and the potential timeline for labor. Additionally, follow-up appointments may be scheduled to evaluate the progress of cervical ripening and to determine the next steps in the labor induction process.
| Short Descr | INSERT CERVICAL DILATOR | Medium Descr | INSERTION CERVICAL DILATOR SEPARATE PROCEDURE | Long Descr | Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 141 - Other therapeutic obstetrical procedures |
| 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 47 | Anesthesia by surgeon: regional or general anesthesia provided by the surgeon may be reported by adding modifier 47 to the basic service. (this does not include local anesthesia.) note: modifier 47 would not be used as a modifier for the anesthesia procedures. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | AG | Primary physician | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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