Wiki 59400 and prior complications

[rykin7609]

I am new to this area of coding and have come across a physician billing 59400 which he should because he has seen the patient throughout the pregnancy and delivery.

The question is, can I also bill for an H&P and 2 subsequent hospital visits prior to the delivery because of complications. The patient had "rupture of membranes" and spent 4 days in one hospital then tranferred to another and spent another 4 days at second hospital before delivering. The patient was also going into premature labor and had a prior history of this.

I believe I am able to bill for this H&P plus 2 subsequent visits by my doctor. I think I will have to leave the one prior to delivery and day of delivery in the global period and a zero charge. Is this correct?

Also, if I AM able to bill for those three days of hospital stay, will I need a modifier 24 showing this as something above and beyond the normal pregnancy and delivery?

Thank you, I appreciate all the help I can get.
Allana T CPC, CCAT

 

[tdybear829@aol.com]

Yes, hospital visits are NOT included in the global maternity structure. So, NO, you should not need a 24 modifier. Just make sure to use the dx of 'premature rupture of membranes' to acknowledge this is a "complication of pregnancy" and therefore, not included. You can bill for any visits up to 24 hours prior to delivery. Also, did your Dr deliver your patient? If he/she did NOT deliver, you cannot bill for the delivery and should bill CPT 59425/59426 depending on how many visits the patient had in office.

 

[rykin7609]

Thank you, we were leaning that way but we just wanted to make sure by asking someone who has done this before.

Thanks!