Wiki 59430 Postpartum visit

[arrana]

Hi,

We have a patient who had all of her prenatal care with us at our community health center clinic, she delivered in the hospital, then returned to us 4 days later for a postpartum complication of incontinence. The provider documented that it is a complication relating to delivery/postpartum. My question is this: would this visit be coded with the 59430 postpartum only care code, or as a regular office visit 99213? It is the understanding of my provider that the 59430 is for the 6 week postpartum visit only, and the CPT manual isn't that specific. And I'm still new enough that I haven't encountered this before.

Thanks for your help!!
Arrana
Billing Specialist
Outer Cape Health Services
Wellfleet, MA

 

[MWilliams01]

59430

59430 should only be billed if your physician is providing the "routine" postpartum care only. If your physician has billed 59400 he has included this piece of the patient care already. The service you have described is not "routine" and therefore is separately billable using the appropriate E/M code. You may have to append the -24 modifier to separate this out and show that this is a complication which is billable outside of the global 59400 code.

 

[arrana]

We did not bill the 59400 as we did not do the delivery, we did all prenatal care only, and this non-routine postpartum. For the prenatal care we billed the 59426. I don't know if the hospital/delivering physician will be billing the 59409 for delivery only, or if they will bill a 59410 for delivery and postpartum...
So is the 59430 for the routine 6 week follow up visit only, when done by a provider other than the delivering provider, or can it be used for any postpartum care provided by a provider other than the delivering provider?

Thanks for the clarification.

 

[AubreyB]

59430 would be appropriate to use if your office is providing all of the patient's postpartum care, including her 6-week postpartum check up. Postpartum care is all care after surgery, not just the 6-week postpartum check. It sounds like if your office provided all of her antenatal care, they will also be providing all of her postpartum care. I would call the other office and see how they billed the delivery. If they did not expect their doctor to take over the patien's postpartum care, then they should have billed out the delivery only code and visa versa.