Ob-Gyn Coding Alert

Question: Patient was seen in the hospital for a c-section, and my ob-gyn assisted. This patient had previously not been seen in our clinic. Patient then comes to our office a month later with an infection of the c-section site. She attempted to get into her primary ob-gyn but, due to COVID, was unable to be seen.

We have not billed out the delivery as per our state Medicaid guideline, our assist claim MUST match the primary surgeon’s in regard to diagnosis codes, and we are waiting for the other clinic’s codes.

My question is which is the most accurate way to bill this? My provider thought it should just be a regular office visit, but I disagree. I’m thinking that it should either be postpartum care (59430) or instead of billing 59514 (Cesarean delivery only) with modifier 80, bill 59515 (Cesarean delivery only; including postpartum care) with modifier 80.

Any suggestions?

Arkansas Subscriber

Answer: First, hopefully your state does not insist that you use the same CPT^® code, because your surgeon only provided assistant services on 59514, not 59515 (which includes postpartum care).

Since he seems to have seen the patient only for the complication, that would not be considered normal postpartum care. So you are billing for the delivery assist independently and for a different date of service (and the delivery ICD-10-CM codes will match).

For the complication, report an evaluation and management (E/M) service only (99202-99215, Office or other outpatient visit …) and use a code that indicates the nature of the complication (which will be an O code). This is not normal postpartum care, so it should be excluded from any global care. Also, you are not the provider of record for the delivery (assisting does not count or, rather, should not count).