Ob-Gyn Coding Alert

The ob/gyn is often not the only physician providing obstetrical care to a patient. In situations involving more than one practitioner, coders need to know what their physician can bill for, what the other physician(s) can bill for and what can be billed concurrently. 
Obstetrical patients may opt to have their family practitioner (FP) handle the majority of their ob care, with the obstetrician handling a complicated labor or delivery only. In other cases, a high-risk pregnancy may be managed by the family practitioner, with input from an ob/gyn or perinatologist.   Global Goes to the FP   When the ob/gyn is the "second-string" physician in a pregnancy, billing of the global obstetrical package is handled by the FP. If all aspects of the pregnancy proceed with no complications, the family practitioner would use a single global code to report the service, either 59400 (routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) or, when a vaginal delivery follows a previous cesarean delivery, 59610 (routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care, after previous cesarean delivery).   Coding for Complications   Complications that occur during delivery alter the coding substantially -- including coding for ante- and postpartum care. An FP may have anticipated providing care from the day the pregnancy was diagnosed (i.e., V22.0, supervision of normal first pregnancy, or V22.1, supervision of other normal pregnancy) until the completion of postpartum care, but clinical conditions may appear during the birth process that alter that expectation.
Among the most common complications are breech delivery or malpresentation (652.xx), disproportion situations (653.xx), fetal distress (656.3x), obstructed labor (660.xx), umbilical cord complications (663.xx) and maternal hypertensive disorders (642.xx). 
When a complication arises and the FP requests the services of a colleague in ob/gyn, one major issue must be resolved -- which of the two doctors handles the care from that point forward? In some instances, the FP may prefer that the ob provide a consultation, simply reviewing the case and making recommendations. In many cases, depending on the complexity of the delivery, the ob would assume full care of the mother due to the ob's higher level of training. But when the specialist is invited to provide only a consultation, the family physician bills the global code 59400, and the ob assigns one of the initial inpatient consultation E/M codes (99251-99255), depending on the level of service provided. In many instances, the highest-level code, 99255, is reported because the presenting problems may be categorized as moderate to severe and the ob could easily spend the 110 minutes noted in that code's description. But, CPT also requires that this level [...]