Wiki 59510, 99223

[Kisha]

pt admitted cpt 99223 on 12/12/11 for icd-9 642.43... on 12/15/11 pt had cpt 59510 c-section, 642.51 ins paid DOS 12/15 but denied 12/12 stating inclusive to 12/15? is this a correct denial or do I need to add a modifier. OB is not my specialty? any help is appreciated.

 

[sandra8215000@gmail.com]

59510 is inclusive of routine care including antepartum care, cesarean. delivery, and post partum care.
There would be a problem with the 642.51 code as it incidactes delivery without mention of antepartum complication yet 642.43 is an antepartum complication.

For cesarean only not including antepartum care you would use 59514.

Don't know if this helps, I am new to coding so not an expert by any means.

Good luck,
Sandra

 

[karitoon]

The admit charge should be payable along with the global delivery fee that was billed since it was for a complication of pregnancy and it is not the day before the delivery occured. The global delivery (59510) does include routine antepartum care including the 24 hours prior to actual delivery date, delivery and postpartum care (inpatient and office). Since the admit occured on 12/12/11 and patient did not deliver until 12/15/11 and the admitting dx was a complication of pregnancy (642.43), you should be able to appeal with medical records and reference CPT and ACOG guidelines. I have this problem repetitively with bc/bs due to their internal system edits. Hope this helps!

 

[Kisha]

That's what I thought Thanks Karitoon