# Coding and Modifier usage for Assisted Cesarean Delivery



## McInroy (Jun 2, 2010)

Patient has seen a Certified Nurse Midwife for all of her prenatal care and expected to deliver vaginally.  However a Physician was called in to perform a Cesarean Delivery Only assisted by the Certified Nurse Midwife.  Patient expects to follow up with the Certified Nurse Midwife for her postpartum care.  I understand that we are able to bill for the entire prenatal global package (59510) in addition to an assisted delivery only (59514).  I need clarification on the modifier usage and which provider should bill each of the delivery codes.  It has been suggested that the Physician should bill for and be credited the entire prenatal global package, but to be accurate the Certified Nurse Midwife provided all of that care as it was assumed that the patient would not require a Cesarean Delivery.  The “only” service the Physician provided was the Cesarean Delivery Only (59514).  Then there is the issue of the assisted delivery on the part of the Certified Nurse Midwife.  It would seem billing the assisted Cesarean delivery only 59514 with an assistant modifier for the Certified Nurse Midwife would be an underestimate of the sum of the prenatal care given by the Certified Nurse Midwife.  And furthermore an overestimate of the Physician's credit for the entire prenatal global package 59510.  In addition to that confusion, I have seen multiple modifiers and any combination thereof, representing an assistant, and again am confused with which modifier represents which provider's services.  Such as: AS, SA, 80, 81.  The following I believe is an accurate representation of services performed, can anyone clarify any of this for me?

Certified Nurse Midwife – 59510-AS (to show recognition for the entire package, but assistance needed at delivery)
Physician – 59514-81 (for reduced assistance for delivery only)


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## bonnyr (Jun 2, 2010)

I work for a CNM who does cesarean assists on her own patients and sometimes for the Ob-Gyn's patients.  We bill as follows:
Antepartum care provided by the midwife, use 59425 or 59426, depending on the number of visits. For hospital admit done by the CNM, bill Initial Hospital care and  the C-section assist, CPT 59514-AS.  Some carriers, like the State of WA  require modifier 80.  If the midwife does the post-partum visits, bill 59430, P/P Care only, to include both the two week, if done and the six week exams.
The Surgeon would bill 59514 for the C-section and followup  hospital visits as subsequent hopsital care and discharge care with diagnosis V67.09 for post surgical follow-up.  The post-surgical followup exam done by the Ob-Gyn should be an E&M code based on the extent of the exam with the V67.09 diagnosis code.

If a tubal was done at the same time, the CNM can also bill the 58611 with modifier AS as well.  The Ob-Gyn would bill the 58611 and ad modifier 25 to the 59514 to indicate this is a separate procedure done at the same time.

Hope this helps.
Bonny


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