59430 billed with an inpatient place of service

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I am seeing a lot of claims for 59430 with an inpatient place of service, I am believing this to be a billing error. The CPT book states " Postpartum care only services (59430) include office and other outpatient visits following vaginal or C-section delivery." I feel that the inpatient service should be billed with an applicable E&M code if the provider did not perform the delivery. Does anyone have any input on this?
 

csperoni

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What exactly is the situation?
My understanding is the postpartum timeframe begins immediately after delivery for 6 weeks.
If the patient is also being seen in office following discharge and billing for 59430, then I would include the hospital visit part of that postpartum service.
If your ob/ob group is seeing the patient only in the hospital following delivery, I would wonder why the ob/ob group who delivered, or provided antepartum, or is providing postpartum is not seeing the patient. It would be unusual from my experience (unless it's solo obs who have a reciprocal arrangement to cover each other and would bill global, not split).
I think some more context about the situation might help.
 
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I have two examples... the same OB group has billed 59612 for the date of delivery, then 59430 with an inpatient POS the next day, then a follow up office 59430 after delivery. I do not feel like the inpatient 59430 should be billed. I know the group should be billing a global code, and I will address that, but they should not have billed that 59430 as inpatient correct because they should have included that in the delivery and postpartum code..
 

nielynco

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59430 includes both inpatient and outpatient PP visits per ACOG and the code was valued under RBRVS accordingly. It is not appropriate for this group to bill 59612 and then 59430 each time thereafter as that would be unbundling. If they did only the delivery (not antepartum) and also provided aftercare in the hospital and outpatient sites the correct code would be 59614. It is not dependent on the same physician in the group practice providing all of these services. 59430 is billed is like a "mini" postpartum global code and it only billed once when reported at all. The CPT rules changed a few years ago to state that if you bill the delivery only code (assuming no antepartum care), but then only did inpatient PP care (but not outpatient), you would report each inpatient visit following the date of delivery and is in patient E/M code, not 59430.
 
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I do have another question that I need some clarification on. We have an OB physician that will cover the weekend shift that is not in our practice. He will only delivery the baby. So I split bill the AP & PP office visits. I normally use the 59430 for the first PP visit when the mom comes back to the office. What I get confused on, if the outside- OB provider delivers the baby, and my provider sees the mom the next day, does my provider get to charge for that next day visit? There are different things I have read, but I was told that I would not charge for the visit in the hospital because our provider would get the PP visit (59430) when the mom follows up in the office. But we have a new provider that came into our practice and she is questioning it and I would like to have a full understanding on this situation. Thank you.
 

nielynco

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I do have another question that I need some clarification on. We have an OB physician that will cover the weekend shift that is not in our practice. He will only delivery the baby. So I split bill the AP & PP office visits. I normally use the 59430 for the first PP visit when the mom comes back to the office. What I get confused on, if the outside- OB provider delivers the baby, and my provider sees the mom the next day, does my provider get to charge for that next day visit? There are different things I have read, but I was told that I would not charge for the visit in the hospital because our provider would get the PP visit (59430) when the mom follows up in the office. But we have a new provider that came into our practice and she is questioning it and I would like to have a full understanding on this situation. Thank you.
As I indicated in my previous answer, 59430 includes all inpatient and outpatient PP visits. If you are split billing then you bill antepartum care and 59430 only for all of the care rendered by your practice. As an aside, many times, a covering physician will not bill at all if they have a formal agreement with the practice to do deliveries. In some cases the practice pays the covering MD, in other cases, each practice covers for each other an no many changes hands and the practice of record bills the entire global code. I would check and see if your practice has any such arranagements.
 
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