Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 08, S. 2010)
The purpose is to enhance the identification and coding system for primary cesarean sections to improve the evaluation of maternal delivery practices among accredited providers.
The new RVS code for primary cesarean section is 59513 with a Relative Value Unit (RVU) of 150.
Surgeons must include the term 'Primary' in the final diagnosis, specify the procedure as 'primary cesarean section,' and write the indication for the initial cesarean section in the patient's operative and delivery records and PhilHealth Claim Form 2.
The circular became effective for patients admitted beginning March 1, 2010.
Codes such as 59514 (Cesarean section, successive), 59525 (Hysterectomy after cesarean section), and 59620 (Cesarean delivery only after attempted vaginal delivery following previous cesarean) remain effective with their respective RVUs.
It is important for quality assurance monitoring and evaluation of accredited providers' practices in maternal delivery management.
The Corporation will require institutional and professional providers to submit the necessary documentation notwithstanding other documents for quality assurance.
The RVU represents the relative cost and complexity of the procedure, used for determining payment and evaluation by PhilHealth.
The circular standardizes the coding, diagnosis terminology, and documentation requirements, facilitating proper claims evaluation and reimbursement by PhilHealth.