Wiki questions pertaining to jan 2023 obgyn newsletter

[Korbc]

In this newsletter they mention if a nurse delivers because the doctor in busy in the next room per say doing something if other people have been using 52 on their global deliveries? and then quote "Be sure to include information about which part of the process they did participate in, so you’ll lessen the impact of any fee reduction the payer might apply." Does that mean to send in our notes to the insurer pointing out what our midwife did? Should I even use 52 if your midwives delivered?

Also another question, I did see this article quote "The delivery-only CPT® code does not include rounding visits in the hospital, nor discharge, which would be coded separately per CPT® instructions"
I don't really see any specific guidelines on how to bill for this, ....... would you code rounding visits as subsequent hosp. care or code the first rounding visit as initial hosp care and then the others as subsequent, and then a discharge day management hosp. code on the day they discharge? And if they deliver and discharge on the same day, even though I don't think I've encountered that yet would you use 99234-99236 with the delivery only code?

Thanks so much!

 

[nielynco]

In this newsletter they mention if a nurse delivers because the doctor in busy in the next room per say doing something if other people have been using 52 on their global deliveries? and then quote "Be sure to include information about which part of the process they did participate in, so you’ll lessen the impact of any fee reduction the payer might apply." Does that mean to send in our notes to the insurer pointing out what our midwife did? Should I even use 52 if your midwives delivered?

Also another question, I did see this article quote "The delivery-only CPT® code does not include rounding visits in the hospital, nor discharge, which would be coded separately per CPT® instructions"
I don't really see any specific guidelines on how to bill for this, ....... would you code rounding visits as subsequent hosp. care or code the first rounding visit as initial hosp care and then the others as subsequent, and then a discharge day management hosp. code on the day they discharge? And if they deliver and discharge on the same day, even though I don't think I've encountered that yet would you use 99234-99236 with the delivery only code?

Thanks so much!

To answer your last question first. This guideline can be found in the CPT Assistant February 2022 / Volume 32 Issue 2: Delivery-only codes 59409, Vaginal delivery only (with or without episiotomy and/or forceps), and 59514, Cesarean delivery only, do not include antenatal or postpartum care. If the private OB/GYN physician group performs the antenatal visits and the delivery, it would report the appropriate E/M code for outpatient care. Because the private OB/GYN group would not be reporting global services, the hospital OB/GYN group may report the appropriate E/M code for the inpatient postpartum care.

But note that all delivery only codes include the initial hospital visit. Therefore, all subsequent visit would be subsequent care by the other provider involved. And yes, you could also bill a discharge day code. If they deliver and discharge on the same day, you can bill just that code if another MD other than the delivering one did the discharge. Usually all services on the date of service are included in the delivery only code.

 

[nielynco]

In this newsletter they mention if a nurse delivers because the doctor in busy in the next room per say doing something if other people have been using 52 on their global deliveries? and then quote "Be sure to include information about which part of the process they did participate in, so you’ll lessen the impact of any fee reduction the payer might apply." Does that mean to send in our notes to the insurer pointing out what our midwife did? Should I even use 52 if your midwives delivered?

Also another question, I did see this article quote "The delivery-only CPT® code does not include rounding visits in the hospital, nor discharge, which would be coded separately per CPT® instructions"
I don't really see any specific guidelines on how to bill for this, ....... would you code rounding visits as subsequent hosp. care or code the first rounding visit as initial hosp care and then the others as subsequent, and then a discharge day management hosp. code on the day they discharge? And if they deliver and discharge on the same day, even though I don't think I've encountered that yet would you use 99234-99236 with the delivery only code?

Thanks so much!

In answer to question 1, we say "nurse" and this means nurse employed by the hospital (and I have personally delivered 10 babies when the MD did not make it when I worked in L&D back in the day), not nurse-midwife. A midwife can bill and nurse cannot. If a billing midwife did the delivery and was a member of the practice of the attending OB you can bill the global usually.

 

[Korbc]

In answer to question 1, we say "nurse" and this means nurse employed by the hospital (and I have personally delivered 10 babies when the MD did not make it when I worked in L&D back in the day), not nurse-midwife. A midwife can bill and nurse cannot. If a billing midwife did the delivery and was a member of the practice of the attending OB you can bill the global usually.

Thank you!!

 

[Korbc]

To answer your last question first. This guideline can be found in the CPT Assistant February 2022 / Volume 32 Issue 2: Delivery-only codes 59409, Vaginal delivery only (with or without episiotomy and/or forceps), and 59514, Cesarean delivery only, do not include antenatal or postpartum care. If the private OB/GYN physician group performs the antenatal visits and the delivery, it would report the appropriate E/M code for outpatient care. Because the private OB/GYN group would not be reporting global services, the hospital OB/GYN group may report the appropriate E/M code for the inpatient postpartum care.

But note that all delivery only codes include the initial hospital visit. Therefore, all subsequent visit would be subsequent care by the other provider involved. And yes, you could also bill a discharge day code. If they deliver and discharge on the same day, you can bill just that code if another MD other than the delivering one did the discharge. Usually all services on the date of service are included in the delivery only code.

Thank you so much! So I just want to make sure I have it clear. The hospital only doesn't have their own OB/GYN group and they use our private practice. If I have a non global person for whatever reason i.e. transfer of care or change of insurance etc, I do already charge out the ante's separate from their delivery. If they receive rounding visit's the day after they deliver I can charge a subsequent hosp visit and If the the subsequent hosp visit is done on the same day as discharge should I just charge the discharge code? And would this only apply to the true delivery only codes of 59409 and 59514 or would it also apply to the delivery only including post postpartum care codes 59410 and 59515 as well? I assume not for 59410 and 59515...... Thank you so much Ms. Nielynco! once again you save the day for me lol!

 

[nielynco]

Thank you so much! So I just want to make sure I have it clear. The hospital only doesn't have their own OB/GYN group and they use our private practice. If I have a non global person for whatever reason i.e. transfer of care or change of insurance etc, I do already charge out the ante's separate from their delivery. If they receive rounding visit's the day after they deliver I can charge a subsequent hosp visit and If the the subsequent hosp visit is done on the same day as discharge should I just charge the discharge code? And would this only apply to the true delivery only codes of 59409 and 59514 or would it also apply to the delivery only including post postpartum care codes 59410 and 59515 as well? I assume not for 59410 and 59515...... Thank you so much Ms. Nielynco! once again you save the day for me lol!

The billing for PP visits would be included in 59410 and 59515 - theses codes include both inpatient and outpatient PP visits, just not the antepartum visits. And yes, per CPT: The hospital discharge day codes 99238 and 99239 include all the E/M services performed on the day of discharge. You will find this rule in the CPT book in a note following code 99239.

 

[Korbc]

The billing for PP visits would be included in 59410 and 59515 - theses codes include both inpatient and outpatient PP visits, just not the antepartum visits. And yes, per CPT: The hospital discharge day codes 99238 and 99239 include all the E/M services performed on the day of discharge. You will find this rule in the CPT book in a note following code 99239.

thanks so much ms.nielynco!

 

[Korbc]

So I'm about to code subsequent care and discharge for a true delivery only 59409 code and the rounding visit and discharge are on the same day! what do you think i should do.... combine the work and do a higher level subsequent care code or do the discharge day management over 30 min 99239? I'm also using diagnosis code of z39.1.
Thanks so much!

 

[nielynco]

So I'm about to code subsequent care and discharge for a true delivery only 59409 code and the rounding visit and discharge are on the same day! what do you think i should do.... combine the work and do a higher level subsequent care code or do the discharge day management over 30 min 99239? I'm also using diagnosis code of z39.1.
Thanks so much!

Per CPT you would only report the discharge code by adding up all the care that day unless they provided admission and discharge services on the same date and then you report a different CPT code.

 

[Korbc]

Per CPT you would only report the discharge code by adding up all the care that day unless they provided admission and discharge services on the same date and then you report a different CPT code.

life savor!! sorry i didn't see that in the book and missed it, i appreciate you!