Ob-Gyn Coding Alert

Warning: Ordering twin delivery codes incorrectly could cost you $582.

Focusing solely on global codes when your ob-gyn or hospital nursing staff performs a delivery will increase your chances of making a costly mistake. Sometimes extenuating circumstances require you to choose from itemized delivery codes -- and use modifiers like 51, 59, and 22.

Face these five delivery myths and uncover the coding reality.

Myth #1: Out-of-Town Ob-Gyn Means You Code Global

Suppose your pregnant patients regular ob-gyn is out of town when the patient goes into labor. Your ob-gyn, who is not affiliated with the regular ob-gyn, performs a normal delivery. If you think this gives you leave to report a global ob code, then youre setting up your claim for disaster.

Reality: You should report the delivery according to how your ob-gyn performed it -- either vaginal (59409, Vaginal delivery only [with or without episiotomy and/or forceps]) or cesarean (59514, Cesarean delivery only).

As for diagnoses, you should use 650 (Normal delivery) and V27.0 (Single liveborn) for a vaginal delivery. These are among the prime diagnoses for deliveries without complications, says Rebecca Lopez, CPC, certified coding specialist at Bright Health Physicians in Whittier, Calif. If the situation calls for a cesarean, you will be reporting a complication code that indicates the reason for the cesarean (for instance,654.2x, Previous cesarean delivery) with the appropriate outcome code (such as V27.0).

You should allow the patients regular ob-gyn to bill for the antepartum visits. The delivery-only CPT code will include rounding visits in the hospital if there are no complications, as well as discharge.

Extra: If your ob-gyn provides all postpartum care services both in and out of the hospital, you should look to 59410 (... including postpartum care). Use V24.2 (Routine postpartum follow-up) for your supporting diagnosis.

Myth #2: Nurse Delivery Means Delivery Code Only

Suppose the nurse delivers the baby because the ob-gyn is in the next room doing a procedure on another patient. Dont fall into the trap of thinking the nurse is providing a separately reportable service.

Reality: No one can bill the delivery, Lopez says.You can use a global code (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy and/or forceps] and postpartum care). You should probably add modifier 52 (Reduced services) to account for the fact that the ob-gyn wasnt present. Be sure to include information about which part of the process he did participate in, so youll lessen the impact of any fee reduction the payer might apply.

Myth #3: 2 Vaginal Deliveries Means 2 Global Codes

One of your ob-gyns regular patients is having twins, and your ob-gyn delivers them both vaginally. Two deliveries, however, do not mean you should submit two global ob codes.

Reality: You should report the global code (59400) for the first baby and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; Multiple procedures) for the second, says Jenny Baker, CPC,COBGC, CPC-I, professional services coder for Oregon Health and Science Universitys Center for Womens Health in Portland, Ore.

Heads up: You should know your payers preferences.Some insurance companies instead prefer that you bill the additional delivery with modifier 59 (Distinct procedural service) attached, Baker says. Other payers will not pay anything additional for twin B when the delivery is vaginal.

Nevertheless, your diagnoses will be 651.01 (Twin pregnancy; delivered, with or without mention of antepartum condition) and V27.2 (Twins, both liveborn).

Myth #4: Vaginal, Then Cesarean? Bill in Order

The ob-gyn delivers the first baby vaginally but the second by cesarean. Even though the ob-gyn performed the vaginal delivery first, that does not mean you should report this code first.

Reality: You should report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) for the second baby and 59409-51 for the first, Baker says. Why: You should bill the cesarean first because 59510 has higher RVUs (relative value units). The RVUs for 59409 are 20.99, and the RVUs for 59510 are 53.24.

Red flag: When the codes are submitted with the lower code first, many payers will pay that at 100 percent of the allowable, but discount the second code by 50 percent. This could mean as much as $581.58 in reduced revenue (based on the Medicare conversion factor of $36.0666 per RVU).

The diagnoses for the vaginal birth will include 651.01 and V27.2.

For the second twin born by cesarean, use additional ICD-9 codes to explain why the ob-gyn had to perform the c-section -- for example, malpresentation (652.6x,Multiple gestation with malpresentation of one fetus or more) -- and the outcome (such as V27.2).

Myth #5: 2 C-Sections Mean 2 Codes

The ob-gyn delivers twins by cesarean. Although you may be tempted to report two codes for two c-sections,you would risk over-reporting your ob-gyns work.

Reality: When the doctor delivers all of the babies -- whether twins, triplets, or more -- by cesarean, you should submit 59510-22 (Increased procedural service).The reason you report only one code is that the ob-gyn is only making one incision, says Christine DuBois, CPC,coding coordinator for Western Mass Physician Associates in Chicopee, Mass.

Highlight: The ob-gyn performed only one cesarean,but modifier 22 shows that the ob-gyn performed a significantly more difficult delivery due to the presence of multiple babies. Important: You will need supporting documentation, DuBois says.

Finally, for the diagnoses, include the reason for the cesarean (651.01) and V27.2.