Ob-Gyn Coding Alert

Two to three times a yearmore often than shed likecoder Jeanne Folmer has to submit charges for an ob patient who has delivered her baby outside of the hospital. Folmer works for Mid-Dakota Clinic in Bismarck, ND, and although Bismarck is the state capital, some patients come from as far away as 150 miles for their care. And sometimes, the baby arrives before the expectant woman reaches the facility.

If the patient delivers in the ambulance, then we dont get the delivery code, Folmer says, noting that the ambulance cant bill for the delivery either. Nobody gets paid for the delivery in this scenario.

Barbara Johnston, senior billing representative for Oak Tree Womens Health in Middleburg Heights, OH, also knows what its like to miss out on billing for a delivery. We had one patient who wanted to deliver at home using a midwife. We dont normally do that, but we had her sign some consent forms, and billed her for the antepartum care only, Johnston says. We then use 59430 (Postpartum Care Only) for the six-week check-up.

Folmer and Johnston face different but related coding dilemmas, each of which involves an ob patient who fails to deliver in the hospital or birthing center. Lets examine each of these situationsand some others similar to themto determine correct coding and ensure optimal reimbursement.

When the Patient Delivers in the Ambulance En Route to the Hospital

The AMA states in the CPT Companion that any time a baby is not delivered by the physician or practice provider, antepartum care should be coded using the partial antepartum codes 59425 (for 4-6 visits) and 59426 (for 7 or more visits). Fewer than 4 visits are coded using the Evaluation and Management (E/M) office codes. The reason for using these antepartum codes instead of the E/M codes is that they carry greater Relative Value Units (RVU).

For postpartum care, the CPT offers only one code59430. This is the code that both Folmer and Johnston use for Postpartum Care Only, regardless of whether the care is provided in the hospital or on an outpatient basis.

There are several modifications to this situation that affect correct coding. For example, the patient may deliver the baby in the ambulance, but she may arrive at the hospital in time for her ob/gyn to deliver the placenta and admit her for a hospital stay. In this case, coders have the option of billing separately for the antepartum care, the postpartum care, and Delivery of the Placenta Only, using 59414. This is what Folmer does. Another option is to bill using the Global ob code (59400), which covers antepartum care, vaginal delivery and postpartum care. This is the billing method that Johnston frequently uses, and [...]