Ob-Gyn Coding Alert

Question: Do most insurances cover E/M codes for patients who are scheduled for an induction, and she does not deliver for 2 to 3 days after she is admitted? Is that included in global? For instance, suppose a patient is admitted for Cytotec on 7/10 and the nurse inserts the cervical ripening. The doctor dictates her antepartum H&P on that day, but the patient has a failed induction, so we stop the induction. We let her rest, and she does not deliver until 7/12. Is all that included in global fee for delivery, or can we bill an E/M with modifier for a failed induction on 7/11? And then bill for Cytotec (CPT^® 59200) on 7/10?

Tennessee Subscriber

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

DOS 7/10 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 it. In your statement, you have indicated that the nurse did it, so you cannot bill it in this case. You would not bill an admit charge as this is included in global services.

DOS 7/11 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.