Ob-Gyn Coding Alert

Question: A family-practice physician admitted a 34-week obstetrical patient on May 21. I was called to consult that day because of pre-eclampsia, and saw her daily in consultation and then decided to deliver her via cesarean. I delivered her on May 24, and she had a postpartum eclamptic seizure and was not discharged until the 30th. At some point, she was transferred to my service. The family-practice doctor coded 59426 (prenatal visits) and 59430 (antepartum care visits). What is the optimal way to code this?
Maryland Subscriber    Answer: You will code for an initial hospital consultation on May 21. After this point, it appears that you took over care, so the rest of the visits will be coded as inpatient subsequent care up until 24 hours prior to delivery (that is, on the 22nd and 23rd). At that point, you bill the code for cesarean delivery only, which includes inpatient hospital follow-up care. The code series for the consultation is 99251-99255; for subsequent hospital care it is 99231-99233; and the code for the delivery is 59514 (cesarean delivery only), since I am assuming that you did not let her go through a trial and that she had not had a previous cesarean. Select your E/M codes based on your documentation. If you think that on May 22 you were invited back again for another consultation service (and were not simply following up at your own initiative) you can bill that as an inpatient follow-up consultation using 99261-99263. CPT is very clear about the use of these follow-up consult codes: "If the physician consultant has initiated treatment at the initial consultation, and participates thereafter in the patient's management, the codes for subsequent hospital care should be used."