Ob-Gyn Coding Alert

Question: My ob-gyn delivered the placenta, and I coded 59414. Then we received a denial that says "included in the flat fee for major service/procedure." We did not bill a global code. The delivery report states she delivered in the ER entrance prior to admission. Should I resubmit with a global code appended with modifier 52?

Ohio Subscriber

Answer: Yes, you should submit a claim with the global code (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) with modifier 52 (Reduced services), provided your practice is the only one to:

• provide this patient with all her prenatal care, and

• see her for postpartum care.

Tip: Any time you decide on split billing for obstetric care, you must bill for all services on the same claim. That way, the payer will understand you are no longer billing globally. That would mean that you should have billed 59426 (Antepartum care only; 7 or more visits), the hospital admission (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...), the subsequent visits (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...), and discharge management codes (99238-99239, Hospital discharge day management ...) as well when you're billing only 59414 (Delivery of placenta [separate procedure]). You could have coded postpartum care (59430, Postpartum care only [separate procedure]) separately after it occurred.

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