READER QUESTIONS:
One Part Not Done by Ob-Gyn? Use 52
Published on Sat Nov 26, 2005
Question: The ob-gyn admits a patient in labor, completes the history and exam, and writes an order for the patient. After he leaves the hospital, labor suddenly escalates, and the nurse actually catches the baby. Can the ob-gyn code for the delivery? If not, how would she report this?
New York Subscriber
Answer: Some payers will accept a global ob code, but you-ll need to add modifier 52 (Reduced services) for the ob-gyn. You should send a letter to the payer indicating what part of the global service the ob-gyn did not provide and why. Some payers will pay the allowable, while some will reduce your fee by some percentage--depending on how much they value the delivery process.
Another option is to itemize the services the ob-gyn performed. You would need to break out the appropriate antepartum code, admission code, delivery of the placenta/episiotomy code, and postpartum care code, depending on your ob record. Most payers do not like to see this type of claim when one physician provides all of the global service and no other physician is coding for a maternity service.
