ED Coding and Reimbursement Alert

Question: If a patient delivers a baby prior to arriving at the emergency department (ED), but the ED provider delivers the placenta and obtains a history and physical, which of the following should we bill?

    59414 (Delivery of placenta [separate procedure])
     59414 and 59430 (Postpartum care only [separate procedure])  
     59414 and 9928X (Appropriate ER E/M)

The CPT Assistant for June 1996 states to bill 59414 and 59430, but they are both "separate procedures" and it just doesn't seem correct.
     
Georgia Subscriber

Answer: The two services are indeed separately identifiable. You can technically report each of them if the emergency physician truly provides the postpartum care follow up - which includes hospital and office visits following delivery - but this would be highly atypical of ED care. You should bill for code 59414 and the appropriate ED evaluation and management (E/M) as documented.
 
For the E/M code, you'll choose one of the following:
 
  99281 - Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem focused history, a problem focused examination, and straightforward medical decision making
  99282 - ...an expanded problem focused history, an expanded problem focused examination, and medical decision making of low complexity
  99283 - ...an expanded problem focused history, an expanded problem focused examination, and medical decision making of moderate complexity
  99284 - ...a detailed history, a detailed examination, and medical decision making of moderate complexity
  99285 - ...a comprehensive history, a comprehensive examination, and medical decision making of high complexity.