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Wiki Prolonged Labor Services
- Thread starter LanaW
- Start date
Prolonged services
I understand your problem. Sometimes these get paid and other times they are not. It adds up to a lot of money to just write off. We use an initial E/M visit and the use the add on codes of 99354-99355.
It might have to do with dx coding. I am wondering if it because we only use the pregnancy code or complication of pregnancy codes. I just read a post today that recommended using 659.91 or 659.92 Unspecified indication for care or intervention related to labor and delivery and then providing sufficient documentation as to WHY there was extensive services provided.
Still new to this myself! Any other suggestions anyone? Looking for answers too.
I understand your problem. Sometimes these get paid and other times they are not. It adds up to a lot of money to just write off. We use an initial E/M visit and the use the add on codes of 99354-99355.
It might have to do with dx coding. I am wondering if it because we only use the pregnancy code or complication of pregnancy codes. I just read a post today that recommended using 659.91 or 659.92 Unspecified indication for care or intervention related to labor and delivery and then providing sufficient documentation as to WHY there was extensive services provided.
Still new to this myself! Any other suggestions anyone? Looking for answers too.
mitchellde
True Blue
If the patient delivers within 24 hours of the admit then you cannot charge the E&M and the prolonged codes. You will charge the delivery code. If the labor is excessive and the provider is in attendance the entire time you can bill the global code with a 22 modifier:
In the code definitions for global care, the word “routine” is an important distinction. Anything considered outside of “routine” care is also outside of global care. For complications of delivery requiring extra work, and when no CPT code is available to describe that work, modifier -22 (unusual procedural services) is a coder’s best line of offense. When a physician spends extra time and management with a patient, attach modifier -22 to the global ob code.
“The modifier indicates a level of service greater than ‘the norm,’” Callaway says, “but physicians will still have to explain the extra work that was done.” The modifier requires a detailed note from the obstetrician that explains rule “ins” and rule “outs” and describes the level of risk to patient and fetus. This, coupled with the ICD-9 codes detailing the condition, will bolster the case for reimbursement.
If you are using the admit E&M with the prolonged codes the provider must be with the patient the entire time, if the delivery does not occur within 24 hours then some payers will allow you to bill the admit, and some will not. However rarely have I observed a provider in attendance with a patient for the entire duration of the labor, so be certain the documentation is very explicit.
In the code definitions for global care, the word “routine” is an important distinction. Anything considered outside of “routine” care is also outside of global care. For complications of delivery requiring extra work, and when no CPT code is available to describe that work, modifier -22 (unusual procedural services) is a coder’s best line of offense. When a physician spends extra time and management with a patient, attach modifier -22 to the global ob code.
“The modifier indicates a level of service greater than ‘the norm,’” Callaway says, “but physicians will still have to explain the extra work that was done.” The modifier requires a detailed note from the obstetrician that explains rule “ins” and rule “outs” and describes the level of risk to patient and fetus. This, coupled with the ICD-9 codes detailing the condition, will bolster the case for reimbursement.
If you are using the admit E&M with the prolonged codes the provider must be with the patient the entire time, if the delivery does not occur within 24 hours then some payers will allow you to bill the admit, and some will not. However rarely have I observed a provider in attendance with a patient for the entire duration of the labor, so be certain the documentation is very explicit.
We have only few CPT codes for the modes of delivery- like, Normal vaginal delivery, forceps/ventouse delivery or cesarean section.
But the complications of labor encountered are many. Whatever the complications of labor process, they are contained within these modes of delivery CPT codes.
The labor course may be spontaneous, precipitate/spurious(early) or prolonged labor.
Now, our topic is prolonged labor. The prolonged labor may be in one of these stages of labor : first or the second stage or both. In whatever stage was it prolonged, the culminating labor mode (here ) code was the vaginal delivery and the CPT available codes could be from either of these - global, vaginal delivery only or vaginal delivery and postpartum care.
As Michellde said the ‘good will modifier’-22 can be appended for the prolonged labor, irrespective of the payer honors it or not.
What I feel is, the modifier can well be appended to potentiate the time and work. But all that is important is the appropriate diagnosis code for the prolonged labor to validate - whether was it during the first stage or second stage or in both stages, or stage unspecified-,662.0x, 662.1x, 662.2x which will bring forth the real prevalent labor complication situation or scenario for the payers to validate the reimbursement.They cannot deny because of its medical necessity
This is just for a small talk only, not intended to intrude( not to be mistaken please)!
But the complications of labor encountered are many. Whatever the complications of labor process, they are contained within these modes of delivery CPT codes.
The labor course may be spontaneous, precipitate/spurious(early) or prolonged labor.
Now, our topic is prolonged labor. The prolonged labor may be in one of these stages of labor : first or the second stage or both. In whatever stage was it prolonged, the culminating labor mode (here ) code was the vaginal delivery and the CPT available codes could be from either of these - global, vaginal delivery only or vaginal delivery and postpartum care.
As Michellde said the ‘good will modifier’-22 can be appended for the prolonged labor, irrespective of the payer honors it or not.
What I feel is, the modifier can well be appended to potentiate the time and work. But all that is important is the appropriate diagnosis code for the prolonged labor to validate - whether was it during the first stage or second stage or in both stages, or stage unspecified-,662.0x, 662.1x, 662.2x which will bring forth the real prevalent labor complication situation or scenario for the payers to validate the reimbursement.They cannot deny because of its medical necessity
This is just for a small talk only, not intended to intrude( not to be mistaken please)!