Revenue Cycle Insider

Question: Do most insurances cover evaluation and management (E/M) codes for patients who are scheduled for an induction, and she does not deliver for two to three days after she is admitted? Is that included in global? For instance, suppose a patient is admitted for Cytotec on 10/10 and the nurse inserts the cervical ripening. The doctor dictates her antepartum history and physical (H&P) on that day, but the patient has a failed induction, so we stop the induction. We let her rest, and she does not deliver until 10/12. Is all that included in global fee for delivery, or can we bill an E/M with modifier for a failed induction on 10/11? And then bill for Cytotec (CPT^® 59200) on 10/10?

Tennessee Subscriber

Answer: For the date span that you have indicated in your post, you should not bill out any E/M codes for the reasons below:

Date of service (DOS) 10/10 is the patient’s admission for induction of labor. You can report 59200 (Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)) outside of the global package on a date before delivery, but only if the physician inserted it. In your statement, you have indicated that the nurse did it, so you cannot bill it in this case. You would not bill an admit charge as this is included in global services.

DOS 10/11 is a day prior to delivery. If an E/M charge goes out, the patient’s insurance will likely deny it because it occurred within 24 hours of delivery. If there is documentation to support medical necessity and the patient was seen more than 24 hours prior to delivery, it could be appealed.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor