Wiki Delivery by one phy and ante by another, Medicaid

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Babsss

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Anniston, AL
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I have a Medicaid patient that delivered with one physician but did not want to return to him. She came in during the 6 week postpartum with a problem of disruption of perineal ob episiotomy. She also had an IUD inserted on this day. I am not sure about the office visit code, E/M new pt or postpartum care only cpt code and the modifier to append to it. Any guidance is appreciated. I have mulled over several options and have gotten more confused.:eek:
 
Regarding the (probable) complication - did an actual transfer of care occur between the two providers?
 
No transfer of care. My doc is just that way. He will see a patient if they want to be seen. She did not want to go back to the primary OB.
 
For global packages generally speaking, services furnished by another provider related to the surgery when transfer of care is not considered global.

Specific to your situation, you have a couple of things going on here. Depending on whether or not the patient saw the original provider after delivery may make things messy when it comes to billing for postpartum care. Before billing anything, I suggest you contact Medicaid for your state (or whatever state the patient has Medicaid through) and verify that the patient hasn't received post care from anyone else already. If the patient is now seeing your provider and the original provider has billed for the entire OB package, which would include the post care, then there's fairly significant problem for your billing. If the original provider did bill for the entire OB package, then the patient's visit to your provider may or may not be considered post care. Also, some payers consider contraception visits not included while others do; likewise with E/M visits related to problems such as the episiotomy issue in your case.

It all boils down to your state's Medicaid policies AND how the original provider billed. I don't think you can do anything without having a discussion with MD first.
 
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