Revenue Cycle Insider

Question: Do most payers cover evaluation and management (E/M) codes for patients who are scheduled for an induction, and they do not deliver for two to three days after they are admitted? Is that included in global?

For instance, suppose a patient is admitted for Cytotec on 4/10 and the nurse inserts the cervical ripening. The doctor dictates their antepartum history and physical (H&P) on that day, but the patient has a failed induction, so they stopped the induction. The providers let the patient rest, and they do not deliver until 4/12.

Is all that included in global fee for delivery, or can we bill an E/M with modifier for a failed induction on 4/11? And then bill for Cytotec (CPT^® 59200) on 4/10?

Tennessee Subscriber

Answer: For the date span that you have indicated, you should not bill out any E/M codes for the reasons below:

• Date of service (DOS) 4/10 is the patient’s admission for induction of labor. You can report 59200 (Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)) outside of the global package on a date before delivery, but only if the physician inserted the dilator. In your statement, you have indicated that the nurse did it, so you cannot bill it in this case. You would not bill an admission charge as this is included in global services.
• DOS 4/11 is a day prior to delivery. If an E/M charge goes out, the patient’s insurance will likely deny it because it occurred within 24 hours of delivery. If there is documentation to support medical necessity and the patient was seen more than 24 hours prior to delivery, it could be appealed.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor