Wiki OB Complication

[sdwasinger]

I have done limited OB billing and could really use help with this one. What would you code for the following?

Day 1: Patient went into spontaneous labor with vaginal delivery (my doctor did all prenatal care and will do postpartum). The patient retained the placenta, and my doctor did a manual extraction. She then "managed her postpartum hemorrhage". Another doctor did the D&C. Total time with patient 6 hours.
Day 2: 3 hours face to face with patient dealing with her hypotension and tachycardia.
Day 3: 1 hour on discharge

I am thinking...
59400 for OB package
would you add a -22 for extended care, an E/M for the postpartum hemorrhage, or is it global?
Day 2 99232, 99356x1, 99357x4
Day 3 99239

Thank you for your help!

 

[aslonsky]

You cannot bill any rounds/discharge if you are billing the global delivery until day 4. If the physician had to take the patient to the operating room for the manual extraction of the placenta you may be able to get 59414 with modifier 58, but you will probably have to fight with the payer. As for the management of the hemorrhage, as i have heard at every ACOG conference i have attended "some are easy, some are hard" but unfortunatley its all global.

 

[sdwasinger]

Thank you for your input. I appreciate the help!