Ob-Gyn Coding Alert

Question: Is an office visit for postpartum mastitis (a complication of the postpartum period) on postpartum day number 10 a billable E/M visit, or is it included in the global package and therefore not a billable visit?

Nevada Subscriber

Answer: Complications in the postpartum period are billable unless your payer has told you in writing (or their manual, or your contract) that you cannot bill for them. The only question is whether you bill the E/M service using modifier -24 (unrelated E/M service by the same physician during a postoperative period). You can use this modifier if you can say that the mastitis (675.1x, 675.2x) is not related to the recovery from the delivery, which is likely.

So use the -24 modifier on the E/M visit. If you are seeing her for a scheduled postpartum check following delivery and she comes in with this problem, you have the option to bill the E/M service with modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). Make sure your documentation supports billing a significant E/M service for this problem.