Wiki questions pertaining to jan 2023 obgyn newsletter

[Korbc]

In this newsletter they mention if a nurse delivers because the doctor in busy in the next room per say doing something if other people have been using 52 on their global deliveries? and then quote "Be sure to include information about which part of the process they did participate in, so you’ll lessen the impact of any fee reduction the payer might apply." Does that mean to send in our notes to the insurer pointing out what our midwife did? Should I even use 52 if your midwives delivered?

Also another question, I did see this article quote "The delivery-only CPT® code does not include rounding visits in the hospital, nor discharge, which would be coded separately per CPT® instructions"
I don't really see any specific guidelines on how to bill for this, ....... would you code rounding visits as subsequent hosp. care or code the first rounding visit as initial hosp care and then the others as subsequent, and then a discharge day management hosp. code on the day they discharge? And if they deliver and discharge on the same day, even though I don't think I've encountered that yet would you use 99234-99236 with the delivery only code?

Thanks so much!

 

[nielynco]

In this newsletter they mention if a nurse delivers because the doctor in busy in the next room per say doing something if other people have been using 52 on their global deliveries? and then quote "Be sure to include information about which part of the process they did participate in, so you’ll lessen the impact of any fee reduction the payer might apply." Does that mean to send in our notes to the insurer pointing out what our midwife did? Should I even use 52 if your midwives delivered?

Also another question, I did see this article quote "The delivery-only CPT® code does not include rounding visits in the hospital, nor discharge, which would be coded separately per CPT® instructions"
I don't really see any specific guidelines on how to bill for this, ....... would you code rounding visits as subsequent hosp. care or code the first rounding visit as initial hosp care and then the others as subsequent, and then a discharge day management hosp. code on the day they discharge? And if they deliver and discharge on the same day, even though I don't think I've encountered that yet would you use 99234-99236 with the delivery only code?

Thanks so much!

To answer your last question first. This guideline can be found in the CPT Assistant February 2022 / Volume 32 Issue 2: Delivery-only codes 59409, Vaginal delivery only (with or without episiotomy and/or forceps), and 59514, Cesarean delivery only, do not include antenatal or postpartum care. If the private OB/GYN physician group performs the antenatal visits and the delivery, it would report the appropriate E/M code for outpatient care. Because the private OB/GYN group would not be reporting global services, the hospital OB/GYN group may report the appropriate E/M code for the inpatient postpartum care.

But note that all delivery only codes include the initial hospital visit. Therefore, all subsequent visit would be subsequent care by the other provider involved. And yes, you could also bill a discharge day code. If they deliver and discharge on the same day, you can bill just that code if another MD other than the delivering one did the discharge. Usually all services on the date of service are included in the delivery only code.

 

[nielynco]

In this newsletter they mention if a nurse delivers because the doctor in busy in the next room per say doing something if other people have been using 52 on their global deliveries? and then quote "Be sure to include information about which part of the process they did participate in, so you’ll lessen the impact of any fee reduction the payer might apply." Does that mean to send in our notes to the insurer pointing out what our midwife did? Should I even use 52 if your midwives delivered?

Also another question, I did see this article quote "The delivery-only CPT® code does not include rounding visits in the hospital, nor discharge, which would be coded separately per CPT® instructions"
I don't really see any specific guidelines on how to bill for this, ....... would you code rounding visits as subsequent hosp. care or code the first rounding visit as initial hosp care and then the others as subsequent, and then a discharge day management hosp. code on the day they discharge? And if they deliver and discharge on the same day, even though I don't think I've encountered that yet would you use 99234-99236 with the delivery only code?

Thanks so much!

In answer to question 1, we say "nurse" and this means nurse employed by the hospital (and I have personally delivered 10 babies when the MD did not make it when I worked in L&D back in the day), not nurse-midwife. A midwife can bill and nurse cannot. If a billing midwife did the delivery and was a member of the practice of the attending OB you can bill the global usually.

 

[Korbc]

In answer to question 1, we say "nurse" and this means nurse employed by the hospital (and I have personally delivered 10 babies when the MD did not make it when I worked in L&D back in the day), not nurse-midwife. A midwife can bill and nurse cannot. If a billing midwife did the delivery and was a member of the practice of the attending OB you can bill the global usually.

Thank you!!

 

[Korbc]

To answer your last question first. This guideline can be found in the CPT Assistant February 2022 / Volume 32 Issue 2: Delivery-only codes 59409, Vaginal delivery only (with or without episiotomy and/or forceps), and 59514, Cesarean delivery only, do not include antenatal or postpartum care. If the private OB/GYN physician group performs the antenatal visits and the delivery, it would report the appropriate E/M code for outpatient care. Because the private OB/GYN group would not be reporting global services, the hospital OB/GYN group may report the appropriate E/M code for the inpatient postpartum care.

But note that all delivery only codes include the initial hospital visit. Therefore, all subsequent visit would be subsequent care by the other provider involved. And yes, you could also bill a discharge day code. If they deliver and discharge on the same day, you can bill just that code if another MD other than the delivering one did the discharge. Usually all services on the date of service are included in the delivery only code.

Thank you so much! So I just want to make sure I have it clear. The hospital only doesn't have their own OB/GYN group and they use our private practice. If I have a non global person for whatever reason i.e. transfer of care or change of insurance etc, I do already charge out the ante's separate from their delivery. If they receive rounding visit's the day after they deliver I can charge a subsequent hosp visit and If the the subsequent hosp visit is done on the same day as discharge should I just charge the discharge code? And would this only apply to the true delivery only codes of 59409 and 59514 or would it also apply to the delivery only including post postpartum care codes 59410 and 59515 as well? I assume not for 59410 and 59515...... Thank you so much Ms. Nielynco! once again you save the day for me lol!

 

[nielynco]

Thank you so much! So I just want to make sure I have it clear. The hospital only doesn't have their own OB/GYN group and they use our private practice. If I have a non global person for whatever reason i.e. transfer of care or change of insurance etc, I do already charge out the ante's separate from their delivery. If they receive rounding visit's the day after they deliver I can charge a subsequent hosp visit and If the the subsequent hosp visit is done on the same day as discharge should I just charge the discharge code? And would this only apply to the true delivery only codes of 59409 and 59514 or would it also apply to the delivery only including post postpartum care codes 59410 and 59515 as well? I assume not for 59410 and 59515...... Thank you so much Ms. Nielynco! once again you save the day for me lol!

The billing for PP visits would be included in 59410 and 59515 - theses codes include both inpatient and outpatient PP visits, just not the antepartum visits. And yes, per CPT: The hospital discharge day codes 99238 and 99239 include all the E/M services performed on the day of discharge. You will find this rule in the CPT book in a note following code 99239.

 

[Korbc]

The billing for PP visits would be included in 59410 and 59515 - theses codes include both inpatient and outpatient PP visits, just not the antepartum visits. And yes, per CPT: The hospital discharge day codes 99238 and 99239 include all the E/M services performed on the day of discharge. You will find this rule in the CPT book in a note following code 99239.

thanks so much ms.nielynco!

 

[Korbc]

So I'm about to code subsequent care and discharge for a true delivery only 59409 code and the rounding visit and discharge are on the same day! what do you think i should do.... combine the work and do a higher level subsequent care code or do the discharge day management over 30 min 99239? I'm also using diagnosis code of z39.1.
Thanks so much!

 

[nielynco]

So I'm about to code subsequent care and discharge for a true delivery only 59409 code and the rounding visit and discharge are on the same day! what do you think i should do.... combine the work and do a higher level subsequent care code or do the discharge day management over 30 min 99239? I'm also using diagnosis code of z39.1.
Thanks so much!

Per CPT you would only report the discharge code by adding up all the care that day unless they provided admission and discharge services on the same date and then you report a different CPT code.

 

[Korbc]

Per CPT you would only report the discharge code by adding up all the care that day unless they provided admission and discharge services on the same date and then you report a different CPT code.

life savor!! sorry i didn't see that in the book and missed it, i appreciate you!

 

[Korbc]

In answer to question 1, we say "nurse" and this means nurse employed by the hospital (and I have personally delivered 10 babies when the MD did not make it when I worked in L&D back in the day), not nurse-midwife. A midwife can bill and nurse cannot. If a billing midwife did the delivery and was a member of the practice of the attending OB you can bill the global usually.

Hey Nielynco!

going back to this real quick! our practice small private practice and local hospital uses our doctors, if regular nurse employed by hospital delivers not nurse midwife employed by us can i still bill global or global with 52, and what if doctor was in the room and did not deliver but hospital nurse delivered? According to this that someone else found from acog it seems like i can still charge?

 

[nielynco]

Hey Nielynco!

going back to this real quick! our practice small private practice and local hospital uses our doctors, if regular nurse employed by hospital delivers not nurse midwife employed by us can i still bill global or global with 52, and what if doctor was in the room and did not deliver but hospital nurse delivered? According to this that someone else found from acog it seems like i can still charge?

ACOG is of the opinion you can bill without the modifier -52, but in the end if the payer asks to see the documentation, they might not agree. I also added some newer information from ACOG on another post that you should check out. It looks like pregnancy coding may be going to change a bit in 2027.

 

[Korbc]

ACOG is of the opinion you can bill without the modifier -52, but in the end if the payer asks to see the documentation, they might not agree. I also added some newer information from ACOG on another post that you should check out. It looks like pregnancy coding may be going to change a bit in 2027.

Thank you so much Nielynco! i did see the new changes! there's a lot of change! i really appreciate it So according to ACOG then could i charge with a 52 even if my doctors are not employed by the hospital and are subcontracted i just want to make sure. We do charge when our midwives and doctors deliver but not when one of their nurses deliver but it seems like when a hospital staff nurse delivers i can still charge just with the 52....

thanks so much!

 

[Korbc]

ACOG is of the opinion you can bill without the modifier -52, but in the end if the payer asks to see the documentation, they might not agree. I also added some newer information from ACOG on another post that you should check out. It looks like pregnancy coding may be going to change a bit in 2027.

Hey! so i just wanted to double check my doctors are not employed by the hospital so even if a nurse delivers but if the doctor makes it for the delivery of the placenta i can still charge global? I had always broken the package up if they didn't deliver the baby and if they delivered the placenta i would charge 59414 delivery placenta only but since i can charge global then would placenta only delivery be used by a physician that did not provide prenatal ob care at all?
thanks!

 

[nielynco]

Hey! so i just wanted to double check my doctors are not employed by the hospital so even if a nurse delivers but if the doctor makes it for the delivery of the placenta i can still charge global? I had always broken the package up if they didn't deliver the baby and if they delivered the placenta i would charge 59414 delivery placenta only but since i can charge global then would placenta only delivery be used by a physician that did not provide prenatal ob care at all?
thanks!

I am not clear on what you are asking. If any physician in your practice for whom you bill (and including any physician with whom you have a covering agreement) does not make it for the delivery, but does make it for the delivery of placenta you have 2 options in my opinion: bill globally with a modifier -52 or break up the global code and bill separately for the delivery of the placenta (and this latter option is what CPT published in March 2022 as part of their Knowledge Base questions). I do not agree with ACOG that you could bill globally with no modifier. Use of the modifier -52 is "truth in coding" in my opinion. And just so you can see the context of the work involved (or reductions in payment you might expect with the use of modifier -52), the approximate percentages used to value the global codes (and which were then applied to come up with the delivery only service codes) are:

Antepartum care - 41% of the work
Admission H&P and labor management - 36% of the work
Vaginal delivery - 15% of the work (this would include delivery of the placenta and episiotomy if performed)
Postpartum care (includes inpatient and outpatient visits) - 8% of the work

The physician work RVU for the vaginal delivery only code is 14.37. The work includes includes admission to the hospital, the admission history and physical examination, management of uncomplicated labor (including induction of labor is performed), vaginal delivery (with or without episiotomy, with or without forceps), delivery of the placenta and episiotomy (if performed).

And now the value of the work for the parts:
Delivery of the placenta has only 1.61 work RVUs
Episiotomy has only 2.41 work RVUs

Once you do the math would will see that it leaves 10.35 work RVUs for delivering the baby and the E/M work involved with admission and labor management. Therefore, if the physician in question does all the work but catching the baby, your reduction in payment would be miniscule or even not reduced at all. If the physician in question did not do the required E/M work, no episiotomy was required and only did the delivery of the placenta, use of the -52 modifier would get you a much larger payment reduction.

Now what will happen to all this happy "mathing" is anyone's guess come 2027. We shall have to wait and see whether any global concepts survive the revisions. Perhaps we will end up with something like a Chinese menu approach where we get to pick the individual services provided to get the full picture.

 

[Korbc]

I am not clear on what you are asking. If any physician in your practice for whom you bill (and including any physician with whom you have a covering agreement) does not make it for the delivery, but does make it for the delivery of placenta you have 2 options in my opinion: bill globally with a modifier -52 or break up the global code and bill separately for the delivery of the placenta (and this latter option is what CPT published in March 2022 as part of their Knowledge Base questions). I do not agree with ACOG that you could bill globally with no modifier. Use of the modifier -52 is "truth in coding" in my opinion. And just so you can see the context of the work involved (or reductions in payment you might expect with the use of modifier -52), the approximate percentages used to value the global codes (and which were then applied to come up with the delivery only service codes) are:

Antepartum care - 41% of the work
Admission H&P and labor management - 36% of the work
Vaginal delivery - 15% of the work (this would include delivery of the placenta and episiotomy if performed)
Postpartum care (includes inpatient and outpatient visits) - 8% of the work

The physician work RVU for the vaginal delivery only code is 14.37. The work includes includes admission to the hospital, the admission history and physical examination, management of uncomplicated labor (including induction of labor is performed), vaginal delivery (with or without episiotomy, with or without forceps), delivery of the placenta and episiotomy (if performed).

And now the value of the work for the parts:
Delivery of the placenta has only 1.61 work RVUs
Episiotomy has only 2.41 work RVUs

Once you do the math would will see that it leaves 10.35 work RVUs for delivering the baby and the E/M work involved with admission and labor management. Therefore, if the physician in question does all the work but catching the baby, your reduction in payment would be miniscule or even not reduced at all. If the physician in question did not do the required E/M work, no episiotomy was required and only did the delivery of the placenta, use of the -52 modifier would get you a much larger payment reduction.

Now what will happen to all this happy "mathing" is anyone's guess come 2027. We shall have to wait and see whether any global concepts survive the revisions. Perhaps we will end up with something like a Chinese menu approach where we get to pick the individual services provided to get the full picture.

hahahahaha!!! "chinese menu" thank you! i figured it out the circumstance when placenta only is billed and my whole global delivery scenario. I'm using 52 now and charging global. we provided the prenatal and will be providing pp care and delivered placenta but just not the baby and i had always thought before you couldn't charge global if you didn't deliver the baby in that scenario i provided so glad i now know i can
thanks!!