Ob-Gyn Coding Alert

Although any complications that arise during the global period for postpartum care must be coded and billed with that global coverage in mind, most post-cesarean complications are billable. 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, depending on the carrier. 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 coders should separately report the medical and surgical complications of pregnancy. The American College of Obstetrics and Gynecology (ACOG) publishes an annual coding manual, Components of Correct Procedural Coding, based on CPT guidelines that provides additional information for coders about what can be reported outside of the global period, says Melanie Witt, RN, CPC, MA, an independent ob/gyn coding consultant in Fredericksburg, Va. The guide lists CPT codes most pertinent to the ob/gyn specialty, services included in global billing, and services excluded and therefore separately billable. Know What 59510 Includes The following services are included in the postpartum portion of the 59510 global service, according to the guide: Recovery room visit Uncomplicated inpatient hospital postpartum visits Uncomplicated outpatient visits until six weeks postpartum Removal of sutures, staples. The global service also includes routine follow-up care, according to ACOG guidelines. This follow-up includes checking an incision during a post-op visit and cleaning and redressing the surgical wound. But coders risk losing out on reimbursement if they assume that the global service also includes other, more complicated care that sometimes must happen after cesarean surgery. Procedures not included in the postpartum services for 59510 are: 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 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. ACOG considers treatment for any of these conditions separate from routine global post-op care. Individual carriers, however, do not always reimburse based on ACOG's guidelines, and you may have to appeal to receive proper payment, warns Peggy Stilley, CPC, office manager for Women's Heathcare Specialists, an Oklahoma University-based private ob/gyn practice in Tulsa. "We appeal based on how regularly we perform the procedure and the amount of potential reimbursement that is involved. But carriers' internal policies shouldn't stop you from billing accurately," she maintains. The nature of the complication determines how you should bill and code it. Minor infection Suppose you are coding a wound or breast infection that the [...]