C/S, 59514, with inpt hospital discharge 99238

Shawna Paul

Omak, WA
Best answers
Our OB/GYN performed a C/S for another clinic. We billed 59514 and, since 59514 does not have a global period and CPT states we can bill discharge care with 59514, we billed 99238 for discharge day services.

We have received a denial stating that the 99238 is bundled with 59514 per NCCI edits.

Any thoughts on this situation?

The insurance is stating that the discharge care is included or incidental to the surgery(Csection). Or rather, it is seen as postop care of the patient and cannot be charged. I would have to give them this one as I have not seen an OB charge for a C/S and then charge separately for discharging the patient home.
Coding Specialist

Only codes 59510 and 59515 are listed with the CCI edit. CPT code book states - when billing delivery only services report inpatient post delivery management and discharge services using E&M service codes. I would appeal with Page 300 of your CPT book.:)