Ob-Gyn Coding Alert

Question: We-ve been having trouble with insurance reimbursement for the assistance of a second physician who is an active participant during the vaginal birth of twins. We-ve been using 99360 (Physician standby service ...). Payers indicate to us that they will not pay for -standby- charges. Is there a better way to code for this?


Nebraska Subscriber

Answer: You could code for an ob-gyn who is an active participant in several ways. For instance, if the delivering ob-gyn sought the second ob-gyn's advice regarding the management of a difficult birth, you can report a consultation (99251-99255) and then prolonged ob-gyn inpatient services (99356-99357) if the second ob-gyn's time with the patient exceeded your consultation code's typical time by 30 minutes. 

Alternatively, consider coding the second ob-gyn as an assistant at the vaginal birth by submitting 59409-80 (Vaginal delivery only [with or without episiotomy and/or forceps]; assistant surgeon) if the second ob-gyn assisted with only one of the babies. If the second ob-gyn assisted with both, you should add modifier 59 (Distinct procedural service) to 59409-80.

In this case, you would need to send in documentation with the claim showing the second ob-gyn's involvement. Make sure the documentation establishes the medical necessity of his presence. For example, the fetus was in trouble.

At times, a payer will flatly refuse to pay the second ob-gyn for the work he did. At that point, either you just give away a free service or you decide to charge the delivering ob-gyn for your help. The reason is the delivering ob-gyn would have reimbursement for the full global service despite the second ob-gyn having provided some of the care (assuming that the two ob-gyns have no formal -covering- type of agreement).

The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Guadalupita, N.M.