C/S, 59514, with inpt hospital discharge 99238

[Shawna Paul]

Our OB/GYN performed a C/S for another clinic. We billed 59514 and, since 59514 does not have a global period and CPT states we can bill discharge care with 59514, we billed 99238 for discharge day services.

We have received a denial stating that the 99238 is bundled with 59514 per NCCI edits.

Any thoughts on this situation?

Thanks,
Shawna

[Bready]

The insurance is stating that the discharge care is included or incidental to the surgery(Csection). Or rather, it is seen as postop care of the patient and cannot be charged. I would have to give them this one as I have not seen an OB charge for a C/S and then charge separately for discharging the patient home.

[kriggleman]

Only codes 59510 and 59515 are listed with the CCI edit. CPT code book states - when billing delivery only services report inpatient post delivery management and discharge services using E&M service codes. I would appeal with Page 300 of your CPT book.