# fetal demise



## jptingh (Jan 4, 2010)

I have been told by one of my physicians that when a patient is admitted for fetal demise and is to deliver vaginally, that typically the physician is never present at the time of the actual delivery.  Usually the nurse is the one present and the physician follows up with the patient afterwards on rounds.  Can you still bil appropriately for the global code 59400 if she was 23 weeks, had antepartum care prior and will have the pp visit with us?


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## Lisa Bledsoe (Jan 4, 2010)

The physician does not do the delivery?  I have never heard of that!


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## mitchellde (Jan 4, 2010)

I am as astounded as Lisa on this.  I do not think a nurse can be the one to delivery the baby whether it is viable or not.  And if the physician does not do the deliver then no you cannot bill for it.


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## jptingh (Jan 4, 2010)

Thank you for the input.  I knew the answer already but wanted to verify my position.
Just spoke with my physician again regarding your responses, which he was just as surprised at.  He clarified that at this early in the pregancy, with the large dose of meds that the patient is given to induce the labor, it does not aways happen right away.  When the patient does go to deliver it is so small that it may happen very quickly and they may not be in attendance. It is not intentionally left to the nurses. They do however, follow up immediately and lots of time the patient requires a D&C for retained placenta.  My misunderstanding on the rounding part.  Howeverm he likens it to a full term precipitous delivery.  He feels that you would still appropriately bill globally if he misses a delivery by minutes.


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