Ob-Gyn Coding Alert

Question: Is there any way to bill for induction of labor of any method in addition to the global ob package?

Arizona Subscriber
 
Answer: ACOG believes that induction of labor is included in the global package as part of labor management for some patients. This is because most physicians do not personally perform the procedure, but only monitor the patient more frequently and, basically, some are easy, some are hard.
 
If the physician personally starts the IV drip and must stay with the patient the entire time and is therefore precluded from doing anything else, you can bill the IV infusion codes 90780 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and 90781 (... each additional hour, up to eight [8] hours). If prostin gel is inserted by the physician more than 24 hours prior to delivery, that too can be billed separately, i.e., 59200 (insertion of cervical dilator [e.g., laminaria, prostaglandin] [separate procedure]).
 
It would be inappropriate to bill the induction as an unlisted service (59899, unlisted procedure, maternity care and delivery) because there are codes in CPT that describe induction 90780/90781 and 59200. If the induction is particularly grueling for the physician, he or she can support the significant additional work by adding modifier -22 (unusual procedural services) to the global ob code.