Ob-Gyn Coding Alert

Question: If a patient is in the hospital for several days being induced for a delivery, are those days billable or included in global? I thought only the day (1) prior to the delivery was inclusive but not prior to that day. Am I wrong?

Georgia Subscriber

Answer: Per CPT^® guidelines and the American Congress of Obstetricians and Gynecologists (ACOG), induction of labor is included in global care. This implies use of IV products that are administered by hospital staff.

Some payers may allow billing for the procedure (59200, Insertion of cervical dilator [eg, laminaria, prostaglandin)] [separate procedure]) for use of a cervical dilator performed 24 hours prior to delivery, but most will not pay for the visits.

If due to induction the physician had to spend more time with the patient than is usually required, you can add a modifier 22 (Increased procedural service) to the global code (such as, 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) along with an explanation of the significant additional care, but I would not plan on being reimbursed for individual visits prior to delivery to monitor labor at term.