Ob-Gyn Coding Alert

Question: If my ob-gyn didn't make it into the room for the baby delivery and delivers only the placenta, can he also bill for admission, subsequent hospital care and discharge services? Or would the placenta's delivery include these E/M services?

Colorado Subscriber

Answer: You have the option of billing globally (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 service). This will tell carriers the ob-gyn provided all of her care except the delivery and another doctor is not billing the delivery.

Otherwise, you would have to bill antepartum care (59425, Antepartum care only; 4-6 visits or 59426, - 7 or more visits) and postpartum care (59430, Postpartum care only [separate procedure]) separately.

In that case, you would report the placenta delivery (59414, Delivery of placenta [separate procedure]) and possibly the admission (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...).

But once you bill for delivery of the placenta, you may not find much success obtaining payment for subsequent visits (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) or discharge (99238-99239, Hospital discharge day management -). Payers frequently bundle these services.