Primary Care Coding Alert

Delivering babies may represent a significant portion of a family practices business. In many cases, coding and billing is a straightforward issue. But when complications arise during a delivery, and a family physician calls in another specialist to assist or take over care, assigning the appropriate codes may pose a major challenge.

CPT 2000 provides specific sets of codes for reporting a wide range of services that may be applied during delivery. Professional coders need to be familiar with how those codes should be applied under which circumstances especially when delivery is anything but routine.

Using Single, Global Codes

When prenatal care, delivery and postpartum care progress with no complications, family practice coders assign a single code to describe the full spectrum of services provided. This code is 59400 (routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). In addition, CPT provides an additional global code to be assigned when a previous cesarean delivery is performed. This code is 59610 (routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care, after previous cesarean delivery).

Note: Two global codes are provided for current cesarean deliveries as well. Although family practitioners seldom provide these services, code 59510 (routine obstetric care, including antepartum care, cesarean delivery, and postpartum care) and 59618 (routine obstetric care including antepartum care, cesarean delivery and postpartum care, following attempted vaginal delivery after previous cesarean delivery) are recommended.

Unfortunately, complications often occur during delivery, which may alter the coding scenario substantially including coding for ante- and postpartum care. A family physician may have anticipated providing care from the day the pregnancy was diagnosed (i.e., V22.2 [normal pregnancy, pregnant state, incidental]) until the completion of postpartum care, but clinical conditions may appear during the birth process that alter that expectation.

Complications during birth happen fairly frequently, says Ron Nelson, president of Health Services Associates Inc., a family practice in Freemont, Mich. What you expect to be routine seldom turns out that way.

Among the most common complications, he adds, are breech delivery and extraction (763.0), other malpresentation, malposition, and disproportion during labor and delivery (763.1), maternal anesthesia and analgesia (763.5), abnormality in fetal heart rate or rhythm during labor (763.82), prolapsed cord (762.4), other compression of umbilical cord (762.5), maternal hypertensive disorder (760.0) or maternal injury (760.5).

Coding for Complications

When a complication arises and the family physician requests the services of a colleague, Nelson says, one major issue must be resolved. When an obstetrician or other specialist is called upon, the question revolves around which of the two doctors provides the direct care from that point forward. In some instances, the family physician may prefer [...]