Ob-Gyn Coding Alert

Question: A patient admitted at 24 weeks with twin pregnancy for rescue cerclage that the ob-gyn was unable to perform. So the ob-gyn admitted the patient for management of incompetent cervix. Fifteen days later, she vaginally delivered one twin, and the ob-gyn placed an emergent cerclage to retain the second twin. Six days later, she delivered second twin by cesarean section for rupture of membranes. First, should I use a global care code (59400) for the vaginal delivery, even though she was only 24 weeks? I assume I would use 59514 for the cesarean delivery of second twin. Would it be more advantageous to bill for each hospital day, or add a modifier to the global code for the hospital days and also because she delivered very early?

Alabama Subscriber

Answer: The answer to the first part of your question is no. For the cesarean, you should report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) with modifier 52 (Reduced services) for a reduced number of antepartum visits prior to the admission.

For the vaginal delivery, you should report 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]) on that date of service.

You should also bill for the placement of the cerclage (59320, Cerclage of cervix during pregnancy; vaginal).

Also, you should report all the inpatient visits (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...) up to the date of delivery of the first twin, then again for the inpatient visits up to the date of the cesarean.

Then, you should not report the visit following the cesarean, as this visit is included in the global service But any way you cut it, be prepared to submit lots of documentation for this case.