Wiki 59430- PP only

[karey]

Does 59430 (PP only)cover the followup while the patient is still in the hospital or does it strictly cover the outpatient PP care only?


Example: Dr. X sees the patient her whole pregnancy. Dr. Y deliveres (not in our group). Dr. X see's the patient after delivery while still in the hospital the next day and then discharges her. The patient comes back to see Dr. X for her routine PP 6 weeks later.

I would bill:
Antepartum care and PP care obviously but would I code the inpatient and discharge? I would think that the PP only code would include hospital f/u.

 

[Bready]

Make sure Dr. Y charges delivery only and not delivery with pp care.

I would think you could charge admit (Dr.X admitted the patient) and then discharge (Dr X). I believe the final exam by Dr. X in the hospital would be included in the discharge code. Dr. X can then charge the 59430 at the first postpartum visit to his office.

 

[Emmy1260]

Refer to the notes in your CPT bood under Maternity Care and Delivery preceeding 59000.

Delivery only (59409,etc) includes admission, H&P, labor and delivery. Report postdelivery and discharge services with E/M codes. If the primary did the inpatient follow-up (postdelivery) and discharge, as well as 6 week postpartum, then bill Antepartum care (59425 or 49426) along with Postpartum care (59430).

Refer to CPT Assist August 2002 for OB package clarification. This states Postpartum care includes inpatient and outpatient services following delivery.

 

[Bready]

I guess the question is when was the patient admitted. If the pt's OB admitted the patient and did the H&P etc anticipating delivery in a day or two, but the patient went into labor and another physician, not associated with the practice delivered the baby, then I still say the OB can charge for the admission although it may have to be appealed. the key is that the total obstetric package was not provided to the patient by the same physician or group practice.