Dear GMG members

Shirodkar

Since GMG underwent coding changes to align to CPT, code 2411 is no longer in use. Code 2411 was previously used for a Shirodkar cerclage.

In CPT, the descriptor for CPT code 59320 is “Cerclage of cervix, during pregnancy, vaginal” which includes both a McDonald and a Shirodkar, it does not differentiate the technique used.

However, SASOG and its affiliate groups believes that McDonald and Shirodkar are two different procedures requiring different skill sets. Therefore, the consensus view is that separate codes are necessary for McDonald and Shirodkar. While the literature search is not always consistent in concluding that a Shirodkar has better outcome, the consensus view is that there are certain instances where a Shirodkar is necessary and where referral to a colleague with the expertise to do a Shirodkar would be necessary, i.e.

• a short cervix;
• ultrasound shows herniation of the membranes at level of internal os of cervix;
• emergency cervical cerclage.

Data from one of the large administrators indicates that before the CPT crosswalks were implemented, 2411 was billed much more frequently than 2409, therefore raising concerns that there may have been upcoding.

GMG is busy revising cervical cerclage codes and is motivating for re-introduction of code 2411.

Utilization data also indicates a small number of practices that use code 2413 “Cerclage of cervix, during pregnancy, abdominal” or code 2410 “Cervical cerclage, any route, non-obstetrical” to code for a Shirodkar or removal of Shirodkar. This is obviously inappropriate. These practices are being monitored by scheme administrators.

In the interim Discovery Health has agreed to the application of Rule J to 2409, where a Shirodkar is done. The indications as above  would have to be applied with the necessary motivation, either clinical or radiographic, to be available when requested.

Members are welcome to send any suggestion on coding changes to info@sasog.co.za accompanying by supporting clinical evidence.

Kind regards
GMG