Deliver Your Delivery Coding From Claim Mishaps With This Expert Advice
Published on Thu Nov 02, 2006
Know what to do when ob-gyn performs c-section for twins
Coding deliveries isn't as easy as simply reporting a global code. Sometimes extenuating circumstances require you to choose from itemized delivery codes -- and use modifiers like 51, 59 and 22.
Read the following four scenarios and see if your answers match up with our experts- guidance. 1. Your Ob-Gyn Delivers for Unaffiliated Ob-Gyn Scenario: A pregnant patient's 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. How should you report this?
Answer: 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), says Cassandra Walker McKibben, billing manager for Regional Obstetrical Consultants in Chattanooga, Tenn.
As for diagnoses, you should use 650 (Normal delivery) and V27.0 (Single liveborn), says Shawna Landstra, biller at Mansion Street Ob-Gyn in Marshall, Mich.
Keep in mind: -You should allow the patient's regular ob-gyn to bill for the antepartum visits. The delivery CPT code will include postpartum visits in the hospital if there are no complications,- as well as discharge, McKibben says.
But if your ob-gyn provides all postpartum care services both in and out of the hospital, you should look to 59410 (... including postpartum care), says Cheryl Ortenzi, CPC, billing and compliance manager for BUOB/Gyn in Boston. Use V24.2 (Routine postpartum follow-up) for your supporting diagnosis, Landstra says. 2. What to Do When Nurse Delivers Instead Scenario: The nurse delivers the baby because the ob-gyn is in the next room doing a procedure on another patient. How should you report this?
Answer: You can use a global code (such as 59400). You should probably add modifier 52 (Reduced services) to account for the fact that the ob-gyn wasn't present. Be sure to include information about which part of the process he did participate in, so you-ll lessen the impact of any fee reduction the payer might apply. 3. Master Multiple-Gestation Deliveries Scenario A: One of your ob-gyn's regular patients is having twins, and your ob-gyn delivers them both vaginally. How should you report this?
Answer A: You should report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for the first baby and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; multiple procedures) for the second, Ortenzi says.
-Modifier 51 on the second code is key for reimbursement,- says Shelley Bellm, CPC, coding manager for Colorado Mountain Medical in Vail, Colo.
Caution: -Some carriers require you to bill vaginal deliveries broken up into two separate codes with modifier 59 (Distinct procedural service) [...]
