Ob-Gyn Coding Alert

Question: We have an ob patient who had only one visit with our physician before she delivered. The doctor wants to report 59400 for total care, but I thought there had to be at least seven visits for total care. How should we code this?

Maryland Subscriber

Answer: Billing for ob global care with 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) usually means that the obstetrician provides approximately 13 visits, and the physician is the only one who provides prenatal care.

If the patient simply showed up just prior to delivery and did not receive any prenatal care from another physician, the American College of Obstetricians and Gynecologists recommends that you report the global code appended with modifier -52 (Reduced services) and link it to a diagnosis of insufficient prenatal care (V23.7).

If the patient transferred to your physician from a different ob, you should bill only for the care provided by your practice, because another doctor will be coding for the care he or she provided. In this case, because the patient saw your obstetrician only once, you would bill this as an E/M service (99201-99205). You should report the delivery with postpartum care code 59410 (Vaginal delivery only [with or without episiotomy and/or forceps]; including postpartum care).

The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.