Ob-Gyn Coding Alert

Question: At my hospital-affiliated family practice clinic the physicians often take care of antepartum care and labor management for high-risk ob patients, but an ob/gyn delivers the baby. We are not clear what we can bill for, versus what the ob/gyn will bill for. For instance, my physician performed prenatal care (which Ive already billed), labor management, IUPC, Fse, and pitocin augmentation. The patient presented to labor and delivery with ruptured membranes.

New Hampshire Subscriber

Answer: First, bill 658.1 (premature rupture of membranes) for the ruptured membranes diagnosis. Second, you can bill the hospital admission code (99221-99223) and any subsequent hospital care if she delivers the next day. The other services are not separately billable because they are considered part of labor management by the physician managing the labor. That rule applies whether that service is eventually billed as a global service, the delivery-only codes (59409, 59514), or as an E/M service by the non-delivering physician. But to bill the E/M services, you need to see what the physician documented in the hospital record and remember that E/M services in the hospital that are prolonged may also lead to coding the prolonged physician services codes if time has been documented in the record.

So your family practitioner will bill for inpatient hospital services preceding delivery using the inpatient hospital codes, 99221-99233. The ob/gyn who did the cesarean bills only for delivery and follow-up on an inpatient basis, assuming that your doctor, and not the ob/gyn, provides outpatient postpartum care.