Ob-Gyn Coding Alert

Question: Fifteen days after her delivery, the ob-gyn admitted a patient to the hospital because she had an infection on the c-section. To bill for the visits, I would like to use modifier 58. Is this correct?


Michigan Subscriber

Answer: No, you should not use modifier 58 (Staged or related procedure or service by the same physician during the postoperative period). The reason is that the E/M encounter is not as extensive as the original procedure, was not planned by your ob-gyn ahead of time, and is not therapy following a diagnostic surgical procedure.

But you can use modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) because this visit is an unexpected complication of the cesarean section. Select the level of service based on the physician's documentation for the admission. Modifier 24 should keep payers from considering the encounter part of the global service.

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