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Ob-Gyn Coding Alert

6 Tips to Rein In Your Global Ob Coding

Published on Sun Sep 25, 2005

Learn how to boost the bottom line for  twin deliveries

Saddle up your claims with the correct ICD-9 code for ob global packages and leave denials in the dust.

The following tips, provided by Laura Knight, CPC, project coordinator of medical services administration at Good Samaritan Community Healthcare at Puyallup, Wash., will ensure your global ob package success every time.

Tip #1: Make sure that all your ICD-9 selections for ob billing are chosen from the 640-678 range of ICD-9 diagnoses.

Tip #2: Always code to the highest specificity when you need to add a fifth digit to denote the episode of care (such as for complications mainly related to pregnancy, 651-659):
 

  • unspecified = 0
     
  • delivered, with or without mention of antepartum condition = 1
     
  • delivered, with mention of postpartum condition = 2
     
  • antepartum condition or complication = 3
     
  • postpartum condition or complication = 4.

    Tip #3: Remember that ICD-9 selection in the 646.x (Other complications of pregnancy, not elsewhere classified) or 648.x (Other current conditions in the mother ...) diagnosis categories requires additional codes to further specify the complication. For example, you'll need to further specify 648.0x (Diabetes mellitus) using a code selected from the 250.xx series (Diabetes mellitus).

    Tip #4: If possible, use the outcome codes for the delivery (V27.0-V27.9).

    Tip #5: If the provider repairs a third- or fourth- degree laceration, don't be afraid to attach modifier 22 (Unusual procedural services). In that situation, ask for extra reimbursement for the extra work.

    Tip #6: Don't miss out on your extra reimbursement for twins. Here's how to report for three types of twin deliveries: 

  • Both vaginally: If your ob-gyn delivers both babies vaginally, you should report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for baby A and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps], multiple procedures) for baby B.
     
  • Both by c-section: If the ob-gyn delivers both babies by c-section, you should report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) and attach modifier 22. Include a letter with the claim that outlines the additional work involved with the multiple procedures to give the carrier a clear picture of why you're asking for additional reimbursement.
     
  • One vaginally, one by c-section: If the ob-gyn delivers baby A vaginally and delivers baby B by c-section, you should report 59510 for the second baby and 59409-51 for the first. Don't forget to use a code in the 651.xx series for multiple gestations, because using one of these codes will insure your claim getting processed quickly.

    Note: Got your own tips for coding global ob packages? E-mail them to me at suzannel@eliresearch and get a free PDF pocket E/M guide or an annual exam letter template, all care of Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Guadalupita, N.M.

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