Ob-Gyn Coding Alert

Question: When a patient delivers elsewhere and comes in for only the postpartum visits (office and hospital), can we bill them?

Connecticut Subscriber

Answer: Yes, you can bill the postpartum visits, but you must clearly identify them as postpartum by reporting 59430 (Postpartum care only [separate procedure]).

You may need to question why your ob-gyn wants to report the hospital visits. The person who performed the delivery is responsible for the inpatient following the delivery. In other words, CPT's delivery only codes include the hospital care following delivery, according to the American College of Obstetricians and Gynecologist (ACOG)'s Ob/Gyn Coding Manual. The Resource-Based Relative Value Scale (RBRVS) system valued these codes based on that assumption.

If, however, your ob-gyn does provide the hospital care, then you should report the delivery only code (such as 59409, Vaginal delivery only [with or without episiotomy and/or forceps]) with modifier 55 (Postoperative management only) to let the payer know the person who billed for the delivery is billing only for the delivery and no aftercare. Using modifier 55 also means that you should no longer use 59430, which implies all postpartum care, not just that in the hospital setting.