Ob-Gyn Coding Alert

Question: I have a quick question about reimbursements from carriers. I was under the impression that a c-section pays more to the ob-gyn than a vaginal delivery. I have one carrier that does pay higher for a c-section than vaginal, but when I look at my other carriers like Aetna, Oxford, BCBS — they pay the same for either/or. Is it true that c-sections should be paid at a different rate that a normal vaginal delivery? The ob-gyn wants me to contact the carriers and state, because they think they are underpaying.

New Mexico Subscriber

Answer: The codes for a cesarean have more relative value units (RVUs) than the codes for a normal vaginal delivery, but not all payers reimburse based on RVUs. Some have decided that they do not want to “reward” physicians for doing cesareans (the number of cesareans births are again on the rise). Instead, they pay the same as a vaginal delivery or less than a vaginal delivery in order to influence (they think) the cesarean rate. But you should definitely check all of your payers to ensure you are being the paid the contracted rate to which you agreed.