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Ob-Gyn Coding Alert

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Reporting Postpartum Visit(s) Only

Published on Thu Mar 05, 2015

Question: We encountered a situation where an established patient delivered elsewhere. Is there a limit to the amount of billable postpartum visits? What are the criteria as it will be non-global? I’ve been told only one can be billed, and that most insurance payers will only pay one. Is that true?

North Carolina Subscriber

Answer: You should use 59430(Postpartum care only [separate procedure]) to report both cesarean and vaginal postpartum (PP) only care.
 
Usually after a cesarean, the ob-gyn would see the patient for two visits. Do not bill for the wound check. 
 
After a vaginal delivery, the ob-gyn would see the patient just once at six weeks.
 
However, in general, unless you are dealing with a complication in the postpartum period, you should consider all routine PP visits included in 59430 up to the six weeks after delivery.
 
Keep in mind: In checking theMedicare resource-based relative value scale(RBRVS) data base — which shows the inputs in determining the value of the code — 59430 was valued based on the assumption that this PP service includes:
  • one 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem-focused history; An expanded problem-focused examination; Medical decision-making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem[s] and the patient’s and/or family’s needs. Usually, the presenting problem[s] are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family)and 
  • one 99214 (…Adetailed history; Adetailed examination; Medical decision-making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem[s] and the patient’s and/or family’s needs. Usually, the presenting problem[s]are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family).
 

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