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Wiki Z39.0

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jengates@pa.gov

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Is this code for professional claims only or is it required for inpatient hospitals to bill a delivery that occurred outside of the hospital without complications?
 
Hi, not quite sure I understand what you're asking. If a delivery occurred outside of the hospital, then a delivery would not be billed, but Z39.0 could be used on any E+M services provided.
 
A question was presented to me regarding inpatient hospital billing for a delivery that occurred outside of the hospital. Since the hospital cannot bill for the delivery, are they required to code the Z39.0 to reflect that the delivery occurred outside of the hospital? Is this z code only used for professional billing on E & M codes? What would the inpatient coding look like for this type of delivery if the mom and baby are admitted after birth for care? Sorry....OB is not my strong suit. :)
 
Well Z39.0 in and of itself doesn't specifically have anything to do with whether the delivery was in hospital or out of hospital. There is no requirement per se to use it, as far as I am aware. Typically the patient would be admitted and stay 1-2 nights if there were no complications, so you would have those E+Ms (admit, subsequent and discharge). There could also be laceration repair, or delivery of the placenta if it hadn't delivered by the time they arrived.
 
The ICD book reads Z39.0 "Care and observation in uncomplicated cases when the delivery occurs outside a healthcare facility."
Guidelines - When the mother delivers outside of the hospital prior to admission and is admitted for routine postpartum care and no complications are noted, code Z39.0. Encounter for care and examination of mother immediately after delivery, should be assigned as the principal diagnosis. So, do you think this can only be coded on professional claims or can this be used on hospital coding to reflect care of a postpartum patient that didn't deliver in their facility? So sorry for all of the questions.
 
jengates@pa.gov said:
The ICD book reads Z39.0 "Care and observation in uncomplicated cases when the delivery occurs outside a healthcare facility."
Guidelines - When the mother delivers outside of the hospital prior to admission and is admitted for routine postpartum care and no complications are noted, code Z39.0. Encounter for care and examination of mother immediately after delivery, should be assigned as the principal diagnosis. So, do you think this can only be coded on professional claims or can this be used on hospital coding to reflect care of a postpartum patient that didn't deliver in their facility? So sorry for all of the questions.
Click to expand...
Yes, you would use it in that situation but it is not limited to that situation.
https://www.aapc.com/codes/coding-n...o-report-for-pp-hospital-visit-171442-article

I don't know what you would use it for on the facility side..
 
Cmama12 said:
Yes, you would use it in that situation but it is not limited to that situation.
https://www.aapc.com/codes/coding-n...o-report-for-pp-hospital-visit-171442-article

I don't know what you would use it for on the facility side..
Click to expand...


I have a situation that goes along with this diagnosis code. I was audited for a subsequent encounter from a cesarean delivery and was counted wrong for using Z39.0 as primary. The auditor stated I should have used O63.1, prolonged second stage of labor and was quoted this:
Chapter 15.4 When a delivery occurs
When an obstetric patient is admitted and delivers during that admission, the condition that prompted the admission should be sequenced as the principal diagnosis. If multiple conditions prompted the admission, sequence the one most related to the delivery as the principal diagnosis. A code for any complication of the delivery should be assigned as an additional diagnosis. In cases of cesarean delivery, if the patient was admitted with a condition that resulted in the performance of a cesarean procedure, that condition should be selected as the principal diagnosis. If the reason for the admission was unrelated to the condition resulting in the cesarean delivery, the condition related to the reason for the admission should be selected as the principal diagnosis
The bold portion was highlighted by the auditor.
I argued that these are the instructions on how to bill the delivery charge, hence the title When a delivery occurs.
The auditor has responded back stating the error will not be removed and quoted the same guideline.
She also originally said I should have used Z37.0 on the subsequent encounter but she did remove that one.
I'm now appealing for a second time!

Cathy
 
cubbiecatz said:
I have a situation that goes along with this diagnosis code. I was audited for a subsequent encounter from a cesarean delivery and was counted wrong for using Z39.0 as primary. The auditor stated I should have used O63.1, prolonged second stage of labor and was quoted this:
Chapter 15.4 When a delivery occurs
When an obstetric patient is admitted and delivers during that admission, the condition that prompted the admission should be sequenced as the principal diagnosis. If multiple conditions prompted the admission, sequence the one most related to the delivery as the principal diagnosis. A code for any complication of the delivery should be assigned as an additional diagnosis. In cases of cesarean delivery, if the patient was admitted with a condition that resulted in the performance of a cesarean procedure, that condition should be selected as the principal diagnosis. If the reason for the admission was unrelated to the condition resulting in the cesarean delivery, the condition related to the reason for the admission should be selected as the principal diagnosis
The bold portion was highlighted by the auditor.
I argued that these are the instructions on how to bill the delivery charge, hence the title When a delivery occurs.
The auditor has responded back stating the error will not be removed and quoted the same guideline.
She also originally said I should have used Z37.0 on the subsequent encounter but she did remove that one.
I'm now appealing for a second time!

Cathy
Click to expand...

Hi Cathy, I agree with you that the guideline referenced is only for the delivery charge, and would not be applicable to a subsequent hospital visit. I am now using Z39.2 on the subsequent charges after discussion; although the above referenced AAPC article states to use the Z39.0.
 
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