Ob-Gyn Coding Alert

Question: When I go back and pro-rate charges on a patient due to insurance changes in the pregnancy and file the effective charges, should I report the following: (1) the antepartum code 59425 or 59426, (2) the E/M code for hospital admission 99234-99236 or 9922x for initial hospital care, and then (3) 59410 for the delivery and postpartum?  In other words, is it OK to report the hospital admission in this instance?

California Subscriber

Answer: CPT makes it pretty clear that delivery services include admission to the hospital and the admission history and physical exam. 
 
If the patient is in labor and the ob-gyn admitted her for delivery and she delivers, you should not report the services the ob-gyn provided within the 24 hours prior to delivery separately whether that involves the hospital admission services or labor management. These services are included in the delivery code you will be billing. ACOG agrees that even the "delivery only" codes would include hospital admission. 
 
If she delivers more than 24 hours after admission and the ob-gyn did not admit her for delivery, but then the patient goes on to deliver, you could appropriately report for the admission separately. However, you'll probably have some difficulty getting reimbursed - especially if the patient is term with no complications other than a very long labor.