Wiki How to bill for AP, CS assist, Hospital Aftercare, and PP

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barbiehays

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I have a dilemma. One of my OB's as has had multiple of the following situations:

The patient is seem by my OB for the entirety of the pregnancy (8 visits). Patient ends up having a c-section by another surgeon with assist by my OB. The surgeon does not see the patient in the hospital after the CS-my OB does all hospital follow-up. Patient is then seen for post partem care by my OB.

Normally, I would say to code this as 59426, 59514-80, 59430. However, since the surgeon is not seeing the patient in the hospital, would I be warrented to attach an additional modifier to the CS denoting my OB did the aftercare? If so, which? I don't think -55 quite fits the bill.

Any suggestions?

Thanks-
Barbie Hays, CPC
 
The surgeon will have 59510. Your OB would have all those as you said- 59426, 59514-80, and 59430.
But in my openion there is no need for a modifier for aftercare because the after care is incorporated into the Postpartum care.
Since the 59430 being a separate procedure, I have yet another school of thought: what if we give 59515-80 for your OB, instead of 59514-80 and 59430;
Would it be undercoding? however my gut feeling says that your codes justify the correct payment modality.
Could any one better refine this doubt with oyur experience/
 
Preserene, you can not add a modifier 80 to 59515. Barbie, you are correct in your coding. (59426, 59514-80, 59430.) 59430 would include the routine hospital care as well as the outpt visits to your clinic. The surgeon would bill the delivery only 59514.
 
Is the 59430 for the inpatient care? What ICD-9 would you append for a normal PP visit? Would they also have a d/c 99238 or 9? What diangosis would you append to that?

Do you get to bill another 59430 for the outpatient 6 week f/u visit or is inclusive of the inpatient visit?

How about the suture removal? If your doc assisted on the c/s, do you code 99024 for the suture removal or bill for an office visit?
 
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