Ob-Gyn Coding Alert

Question: We have a complex situation in which patient gained insurance coverage during the last month of her pregnancy, so we have split her prenatal visits from vaginal delivery accordingly. The same provider that delivered followed the patient in the hospital for immediate postpartum care, but patient failed to show up for her 6 week visit and is now stating that we should not have billed her the 59410 for the delivery, since she did not have her 6 week visit. 

Is this accurate?  Should I have billed 59409 only even though the provider followed her in hospital?  (Incidentally, the same provider did all of her care from beginning of pregnancy to the end.) What should I do? 

South Dakota Subscriber

Answer: Code 59410 (Vaginal delivery only [with or without episiotomy and/or forceps]; including postpartum care) includes BOTH inpatient and outpatient care. The CPT® guidelines state, “The services normally provided in uncomplicated maternity cases include antepartum care, delivery, and postpartum care.”

So long as your ob-gyn documented that you made every attempt to get her to come in for her visit, the American Congress of Obstetricians and Gynecologists (ACOG) says you are entitled to bill this way. Is there some reason she did not come in? And by the way, if you see her for this follow-up even up to three months after birth, you will have fulfilled your obligations to bill this code.