Ob-Gyn Coding Alert

Question: The patient was admitted to the hospital and had a cesarean section on the same day. She had severe toxemia and was discharged four days after delivery. Is any of her subsequent hospital care billable?

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Answer: The global delivery code, whether you are billing for the entire pregnancy or just the delivery portion, includes hospital follow-up for recovery from the cesarean, but it does not include care for complications. You may be able to convince the payer to reimburse for any visits associated with care for the toxemia only (642.54, severe pre-eclampsia; postpartum condition or complication) and an E/M code from the 99231-99233 series (subsequent hospital care, per day, for the E/M of a patient). There is no perfect modifier to use in this case. Modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) is for care unrelated to the pregnancy, and some carriers might think that since the toxemia is related to the pregnancy, it would not be appropriate to use in this case. Modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) would be the better modifier to use (if the payer needs a modifier to bypass the global service), since you are rounding for recovery from delivery and taking care of toxemia problems.

  Answers to Reader Questions and You Be the Coder provided  by Melanie Witt, RN, CPC, MA, an independent coding consultant and ob/gyn coding expert based in Fredericksburg, Va.