Ob-Gyn Coding Alert

Question: How should I properly bill for deliveries for our maternal fetal medicine (MFM) practitioners? We itemize everything, so I use either 59409 or 59410 (Vaginal delivery only ...). If I know the patient is coming back to our office for postpartum care, I usually bill 59410, otherwise I use 59409. If I do bill 59410 but the patient has complications, such as diabetes or pre-eclampsia, then I bill subsequent visits and discharge management. Is this correct?


Tennessee Subscriber


Answer: First, you should ask yourself why you are not billing globally. Second, you can't bill the discharge at all because the delivery code includes this service along with normal postpartum rounding. 

But if you can't bill globally because of payer constraints, then using either 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]) or 59410 (... including postpartum care) is correct under the circumstances. 

If you are going to bill care for complications of pregnancy that are over and above normal postpartum care or hospital rounding, you would need to add modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the service. Caution: You-d better have good documentation that your MFM practitioner treated the patient for the complications, because you will likely have to use the same ICD-9 codes for both the delivery and the aftercare.