Ob-Gyn Coding Alert

Question: Our ob patient presented to the hospital, and the nurse delivered the baby with the emergency department (ED) physician who was on call delivering the placenta. Our ob/gyn assigned to this patient then arrived and performed the episiotomy. I coded the episiotomy repair and the antepartum care, but can I also charge the hospital admit?

Connecticut Subscriber

Answer: Your question is unclear regarding whether the ob/gyn actually admitted the patient to the hospital or if this was done by the ED physician because the nurse delivered her and then the ED physician performed the placenta delivery. If the ob/gyn is not the admitting physician of record, he or she can only bill for the episiotomy (59300, Episiotomy or vaginal repair, by other than attending physician), subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) and postpartum care (59430, Postpartum care only). The ED physician will most likely bill for the delivery.

If he or she does not bill for the delivery, you may be able to make a case for billing the global (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and