PHIC PHILHEALTH CIRCULAR NO. 08, S. 2010, February 22, 2010

[ PHIC PHILHEALTH CIRCULAR NO. 08, S. 2010, February 22, 2010 ]

NEW RVS CODE FOR PRIMARY CESAREAN SECTION

In order to determine the quality of practice of accredited providers in the management of maternal deliveries, there is a need to enhance the identification of such cases specifically the coding system for cesarean section, which is among the top procedures being paid by the Corporation.

As such, a new Relative Value Scale (RVS) code is hereby assigned for all primary (initial) caesarean sections, as follows:

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Code

Decriptive Term

RVU

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59513

Caesarian section, primary

150

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The other codes referable to caesarean section shall remain in effect, as follows:

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Code

Decriptive Term

RVU

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59514

Caesarean section, successive

150

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59525

Hysterectomy after cesarean section

250

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59620

Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery

150

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To facilitate the evaluation of claims, all surgeons performing the above procedures should include the term “Primary” as applicable in the final diagnosis, specify the name of procedures as “primary caesarian section” and write the indication thereto for all initial caesarian sections in the patient’s operative and delivery (OR and DR) records and PhilHealth Claim Form 2. Otherwise, the Corporation shall require institutional and professional providers to submit the said requirements notwithstanding other documents for quality assurance monitoring and evaluation.

This circular shall be effective for all claims for primary caesarian section for patients admitted beginning March 1, 2010.

(SGD.) DR. REY B. AQUINO President and CEO