Ob-Gyn Coding Alert

Question: My practice has encountered many situations where a patient comes in and delivers, but we do not provide the antepartum care. I am coding a cesarean delivery with 59515 (Cesarean delivery only; including postpartum care) if her antepartum care was provided by someone else or if there was no antepartum care.  

I have read conflicting information. One source states the hospital rounds are included in the c-section surgery, and another source states ACOG has re-examined the delivery only codes and has found that the values assigned to the delivery only codes do not include the physician work for the inpatient postpartum care. Yet the delivery with post partum care codes include both inpatient and outpatient post partum care.

Which is correct? I am concerned my physicians will be doing a lot of inpatient postpartum care for free if I code delivery only.

New York Subscriber

Answer: CPT^® clarified last year what is included in each of the delivery codes. This information is found in the maternity guidelines:

Delivery services include admission to the hospital, the admission history and physical examination, management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps), or cesarean delivery. When reporting delivery only services (59409, 59514, 59612, 59620), report inpatient postdelivery management and discharge services using Evaluation and Management Services codes (99217- 99239). Delivery and postpartum services (59410, 59515, 59614, 59622) include delivery services and all inpatient and outpatient postpartum services.

The American Congress of Obstetricians and Gynecologists (ACOG) is in agreement with this revised guideline and had input into formulating it (which means a review of the delivery codes to ensure RVUs were correct).

Bottom line: The payer will decide if they wish to apply some other rule, but even Medicare follows this interpretation. If your physicians are billing the delivery plus postpartum care codes, you should consider all inpatient rounding and discharge management and outpatient postpartum care as included. If you are just doing the delivery and your ob-gyn is not planning on seeing the patient following delivery in the office, you should be billing the delivery only codes -- unless you are otherwise instructed by your payer – and then reporting separately all the inpatient care subsequent to the date of delivery.