Ob-Gyn Coding Alert

During delivery, or when a patient delivers prematurely, a number of complications can arise. The most common ones sometimes require additional procedures, but mostly additional time, from the ob/gyn and attending staff. For many of these complications, the old labor-and-delivery adage "Some are easy, some are hard" rings true. There are ways to increase reimbursement ethically for other complications.
Prolonged Labor
Prolonged labor, defined as active labor that continues more than 18 hours, is most common with first-time mothers. When labor lasts too long, a number of side effects can affect the outcome. The patient can become too exhausted to deliver vaginally, and both mother and fetus are at risk for complications. Typically, a physician will order intravenous fluids to prevent dehydration, then order oxytocin to augment labor contractions. If the cervix does not dilate despite uterine contractions, a cesarean section is usually performed.
 
The codes for prolonged labor are 662.0x (long labor, prolonged first stage), the time from the onset of labor through complete dilation of the cervix; 662.1x (prolonged labor, unspecified); and 662.2x (long labor, prolonged second stage), the time from complete dilation of the cervix through birth of the fetus. A fifth digit is required with these codes to indicate at what point during the pregnancy the complication arose, and if delivery was successful or not.
 
Assuming a scenario where oxytocin is administered and failed to result in labor, and a cesarean delivery is performed, the global code for the ob care package is 59510 (routine obstetric care including antepartum care, cesarean delivery, and postpartum care). The diagnostic code for the cesarean is 659.11 (failed medical or unspecified induction; failure of induction of labor by medical methods, such as oxytocic drugs [Pitocin]). Since the drug is provided by the hospital and will be part of the patient's bill, the ob/gyn does not charge for the drug. Also, in this scenario, the physician cannot bill separately for the IV infusion because it is normally started by hospital nursing staff. 

Labor Management More Than 24 Hours Is Billable
For cases of prolonged labor, coders and physicians should keep an eye on the clock. "Most labor-related in-hospital care rendered more than 24 hours prior to delivery is billable," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C. "For cases where the patient is admitted in labor, or admitted so that labor can be induced, but there is no delivery for 24 hours, additional codes come into play."
 
Use a hospital admit code 99221-99223 (initial hospital care, per day, for the evaluation and management of a patient which requires these three key components: ranging from a detailed to a comprehensive history, a detailed to comprehensive [...]