TanBro
Networker
Ok I just need some clarification. If the patient is in the hospital, doc is in building and arrives for placenta delivery, but RN delivers baby, we still bill delivery with modifier 52 correct?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki NURSE DELIVERS BABY
- Thread starter TanBro
- Start date
This is from an old ACOG document, which indicates the delivery or global could be reported without a 52 if the doctor does arrive in time to deliver the placenta. This is what we follow.
Several factors determine how a missed delivery can be reported. These factors are, if the physician was in route to perform the delivery, if someone else in the practice performed it, and if it were performed by another physician or qualified nonphysician not associated with your practice.
Generally, when the physician has performed all the components of the global package but misses the delivery, the global package may be reported—that is, if the patient arrived at the hospital while the physician was in route and the nurse ended up performing the delivery but the physician arrived in time to deliver the placenta.
On the other hand, if the physician misses the delivery of the baby and the placenta, but arrives in time to take over from there, then it may be appropriate to bill the global code with a modifier 52 attached (i.e., 59400 -52 for a vaginal delivery). The 52 modifier indicates reduced services, since the physician did not perform the delivery. As such, the physician should consider lowering the fee to reflect the reduction in service. This reporting option should not be selected if anyone else is reporting for the delivery.
Several factors determine how a missed delivery can be reported. These factors are, if the physician was in route to perform the delivery, if someone else in the practice performed it, and if it were performed by another physician or qualified nonphysician not associated with your practice.
Generally, when the physician has performed all the components of the global package but misses the delivery, the global package may be reported—that is, if the patient arrived at the hospital while the physician was in route and the nurse ended up performing the delivery but the physician arrived in time to deliver the placenta.
On the other hand, if the physician misses the delivery of the baby and the placenta, but arrives in time to take over from there, then it may be appropriate to bill the global code with a modifier 52 attached (i.e., 59400 -52 for a vaginal delivery). The 52 modifier indicates reduced services, since the physician did not perform the delivery. As such, the physician should consider lowering the fee to reflect the reduction in service. This reporting option should not be selected if anyone else is reporting for the delivery.
mmckibbin
Networker
Are you billing for the provider or the facility? I bill for the provider and we don't put any modifiers on the delivery if the nurse delivers. We are still liable for the delivery and any complications that arise from it, so we bill the same as if we did deliver the baby.
TanBro
Networker
Provider. I believe that is what I ended up doing as well. Thanks
Korbc
Expert
Hey Cmama! is there anyway you can find the article for me and send me the link? I was trained that if the nurse delivers I can't charge for it, but my scenario may be different. The local hospital uses our doctors from a small private practice so the nurse is not our staff member.....i just had a delivery where rn delivered but the doctor was present in the room and wasn't sure i could charge for that and trying to find information.
tHanks so much!
nielynco
True Blue
Just a heads up for everyone. ACOG published this on their website and it indicates that coding for pregnancy care may change in 2027.
In tandem with ACOG’s newly released clinical guidance, Clinical Consensus No. 8: Tailored Prenatal Care Delivery for Pregnant Individuals, ACOG’s Committee on Health Economics and Coding has urged the American Medical Association to change the way obstetric services are billed through the Current Procedural Terminology (CPT®) codes. New codes are anticipated to go into effect on January 1, 2027.
The global obstetric codes no longer reflect the standard of care. Separate billing and payment for ancillary and supportive services, including but not limited to the administration and interpretation of screening (eg, depression, health-related social needs, or social determinants of health), counseling services (eg, genetic, vaccine, nutrition), group prenatal care, education for self-administered monitoring (eg, blood pressure, weight, glucose levels), and other services should be billed separately with the appropriate CPT codes.
The American College of Obstetricians and Gynecologists recommends that Medicaid and commercial payers interested in transitioning from the global obstetric payment utilize the entire catalog of Evaluation and Management (E/M) codes (CPT 99202-99499) without limitations or preauthorization requirements for all prenatal and postpartum visits. It is recommended that the HCPCS modifier “TH” be appended to the E/M code to differentiate the visit as related to the prenatal or postpartum visit.
The current delivery-only codes (59409, 59514, 59612, and 59620) include labor management from the time the patient is admitted to the unit, delivery, and completion of the postpartum orders and birth certificate. Services provided at or near the point of delivery, such as long-acting reversible contraception, should be separately billed.
For labor management that is performed on different calendar days of the delivery, or if performed in another facility on the same day as delivery, inpatient E/M codes (99221-99223, 99231-99233, 99234-99236, and 99238-99239) should be used. Utilizing the inpatient codes in this way will allow multiple hospitals and health care professionals to bill for the services they provide, especially for transfers and multiple days of labor.
Multigestational deliveries should be billed with multiple units of the delivery-only codes with the -51 modifier appended to the subsequent deliveries.
As the new codes are finalized, ACOG will develop resources and provide updates on this webpage. For questions related to this or other coding and policy questions, please go to ACOG’s Payment Advocacy and Policy Portal.
In tandem with ACOG’s newly released clinical guidance, Clinical Consensus No. 8: Tailored Prenatal Care Delivery for Pregnant Individuals, ACOG’s Committee on Health Economics and Coding has urged the American Medical Association to change the way obstetric services are billed through the Current Procedural Terminology (CPT®) codes. New codes are anticipated to go into effect on January 1, 2027.
The global obstetric codes no longer reflect the standard of care. Separate billing and payment for ancillary and supportive services, including but not limited to the administration and interpretation of screening (eg, depression, health-related social needs, or social determinants of health), counseling services (eg, genetic, vaccine, nutrition), group prenatal care, education for self-administered monitoring (eg, blood pressure, weight, glucose levels), and other services should be billed separately with the appropriate CPT codes.
The American College of Obstetricians and Gynecologists recommends that Medicaid and commercial payers interested in transitioning from the global obstetric payment utilize the entire catalog of Evaluation and Management (E/M) codes (CPT 99202-99499) without limitations or preauthorization requirements for all prenatal and postpartum visits. It is recommended that the HCPCS modifier “TH” be appended to the E/M code to differentiate the visit as related to the prenatal or postpartum visit.
The current delivery-only codes (59409, 59514, 59612, and 59620) include labor management from the time the patient is admitted to the unit, delivery, and completion of the postpartum orders and birth certificate. Services provided at or near the point of delivery, such as long-acting reversible contraception, should be separately billed.
For labor management that is performed on different calendar days of the delivery, or if performed in another facility on the same day as delivery, inpatient E/M codes (99221-99223, 99231-99233, 99234-99236, and 99238-99239) should be used. Utilizing the inpatient codes in this way will allow multiple hospitals and health care professionals to bill for the services they provide, especially for transfers and multiple days of labor.
Multigestational deliveries should be billed with multiple units of the delivery-only codes with the -51 modifier appended to the subsequent deliveries.
As the new codes are finalized, ACOG will develop resources and provide updates on this webpage. For questions related to this or other coding and policy questions, please go to ACOG’s Payment Advocacy and Policy Portal.
Unfortunately there is no longer a link for this. It was from at least 5-6 years ago, maybe longer, and ACOG changed their website in that time as well.
Korbc
Expert
thanks! so from what i've seen from that article in a different post,. as long as my doctor who is not personally employed by the hospital but subcontracted delivers the placenta then i can charge global (given they did prenatal and plan on pp care with us)? So when would you just charge delivery of the placenta only because i was charging that instead and breaking up their care since we didn't deliver the actual baby but the hospital staff nurse did. Is placenta only for someone who 1. did not provide prenatal care, 2.is not the attending phys. who delivered the baby and for some reason someone else needed to deliver the placenta?
Korbc
Expert
and of course if they deliver at home with a doula or midwife and not receiving prenatal care with us or deliver in the ambulance and does not receive any prenatal care, from my understanding if we deliver the placenta and provide prenatal care and pp care then i can charge global because we did her other care and would i need to charge global with a 52