Ob-Gyn Coding Alert

Question: One private practice's ob-gyn sees a patient for all of her antepartum visits, while another private practice's ob-gyn does a crash cesarean section (opens and delivers), and the first ob-gyn closes and provides the postpartum. Would the first practice report 59400-52?


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Answer: No, because the second ob-gyn is going to bill for the delivery, which is cesarean, not vaginal. Code 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) would imply a vaginal delivery.

Strategy: You could try billing for the antepartum care (59426, Antepartum care only; 7 or more visits), then the cesarean with the first ob-gyn billing as an assistant (59514-80, Cesarean delivery only; assistant surgeon), then the postpartum care code (59430, Postpartum care only [separate procedure]). 

If the second ob-gyn is not providing any postpartum care, he should append modifier 54 (Surgical care only) to 59514. When you use this modifier, the first ob-gyn should indicate modifier 55 (Postoperative management only) on the same cesarean code. 

Watch out: This is tricky coding, however, that the payer may not accept. Is the first ob-gyn not qualified to perform a cesarean? In that case, why is he closing?

Your claim would be much cleaner if the first ob-gyn just does the postpartum care following the delivery. In that instance, you could use modifiers 54 and 55 without a problem.

Don't forget to report the same delivery code with modifier 80 (Assistant surgeon) as well.