Ob-Gyn Coding Alert

When a physician reports 59510 (routine obstetric care including antepartum care, cesarean delivery, and postpartum care), the global period for postpartum care is usually six weeks. Any complications that arise during this period, whether related to the pregnancy and/or surgery, must be coded and billed with that global coverage in mind. But coders may be surprised to know that most post-cesarean complications are billable.

In the definition for maternity care and delivery services, CPT indicates that the global obstetric package includes antepartum care, delivery services, and inpatient and outpatient postpartum care in uncomplicated maternity cases. CPT further clarifies that medical and surgical complications of pregnancy should be reported separately. Using this definition and that for global surgical care, the American College of Obstetrics and Gynecology (ACOG) publishes an annual coding manual, Components of Correct Procedural Coding. The guide lists those CPT Codes most pertinent to the ob/gyn specialty, lists those services included in global billing, and those excluded and therefore separately billable. This guide can be ordered at ACOGs Web site (http://sales.acog.com) or by telephoning (800) 762-2264.

Know What Is Included in 59510

For 59510, the guide lists the following services as included in the postpartum portion of the global service:

Recovery room visit;

Uncomplicated inpatient hospital postpartum visits;

Uncomplicated outpatient visits until six weeks postpartum; and

Removal of sutures, staples.

Per ACOGs guidelines, routine follow-up care is included in the global service. This includes such things as checking an incision during a post-op visit and cleaning and redressing the surgical wound. But what of other, more complicated care that arises from the cesarean surgery?

The guide goes on to list those procedures not included in the postpartum services for 59510. These include:

Inpatient or outpatient medical problems not related to pregnancy;

Inpatient or outpatient medical problems or complications related to the pregnancy;

Management of surgical problems arising in the postpartum period; and

Tubal ligation during the same hospitalization.

Most Complications Are Billable

Postoperative complications following a cesarean section can range from minor wound infections and breast infections to disrupted sutures, highly septic wounds and internal bleeding. Any of these conditions is considered, per ACOGs interpretation, separate from routine global post-op care. How they are billed and coded will depend on the nature of the complication.

Minor infection For a wound or breast infection that can be treated in the office, the appropriate diagnosis code should be paired [...]