Ob-Gyn Coding Alert

Question: Have a patient who walked into hospital in the middle of the night and delivered the baby before our ob-gyn could get there. So technically, the delivery nurse was the only one there and delivered placenta. Also, our ob-gyn got there to see patient after delivery. Would our visit be considered a postpartum care visit or rounding in hospital visit? Who can legally can bill for delivery and hospital visit? Another doctor's office saw the patient for all her antepartum visits and wants to bill a global fee. They would then pay us for seeing the patient that night of the delivery. What should we report?

Texas Subscriber

Answer: Payers prefer global billing, so if the physician who was her attending of record wants to bill that way and pay you for your services, that would acceptable. 

The ob-gyn of record, however, would have to add a modifier 52 (Reduced services) 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) to indicate that he did not perform the delivery and labor management.  

If you do not go this route (and you really should consult with the physicians involved to see how they want to handle it), the ob-gyn of record could only bill antepartum care, and you would bill for any hospital visits provided following the delivery.

Keep in mind: The postpartum care code is for outpatient postpartum care, not inpatient.