Law Summary
Retention of Existing RVS Codes for Other Caesarean-Related Procedures
- Existing RVS codes for other caesarean-related procedures remain valid and in effect.
- These include:
- Code 59514: Caesarean section, successive (RVU 150)
- Code 59525: Hysterectomy after caesarean section (RVU 250)
- Code 59620: Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery (RVU 150)
Requirements for Documentation and Claim Submission
- Surgeons performing the specified procedures must include the term "Primary" when applicable in the final diagnosis.
- The procedure must be specified as "primary caesarian section."
- The indication for the primary caesarean section must be recorded in the patient's operative and delivery records (OR and DR).
- These details must also be included in the PhilHealth Claim Form 2.
- Noncompliance will prompt PhilHealth to require submission of these documents from institutional and professional providers for quality assurance, monitoring, and evaluation.
Effective Date of the Circular
- These provisions and coding requirements apply to all claims for primary caesarean sections for patients admitted starting March 1, 2010.
Authority and Implementation
- The directive is issued by the President and CEO of PhilHealth, Dr. Rey B. Aquino, ensuring institutional compliance and coordination with billing and claims processes.