Wiki C-Section Assist with Postpartum visit for Infection

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VictoriaOlson

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Hello everyone,

I have a little bit of a dilemma and I'm hoping that someone can help me out. Here is the scenario:

Patient was seen in the hospital for a c-section and my OB assisted. This patient had previously not been seen in our clinic.
Patient then comes to our office a month later with an infection of the c-section site. She attempted to get into her primary OB but due to COVID was unable to be seen.

We have not billed out the delivery as per our state Medicaid guideline our assist claim MUST match the primary surgeon's in regards to diagnosis codes and we are waiting for the other clinic's codes.

My question is which is the most accurate way to bill this? My provider thought it should just be a regular office visit but I disagree. I'm thinking that it should either be postpartum care (59430) or instead of billing 59514 (cesarean delivery only) with modifier 80, bill 59515 (cesarean delivery including postpartum care) with modifier 80.

Any suggestions?
 
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I typically code gyn oncology, not ob, but here's my answer:
59515-80 is off the table as an option, since -80 is not a valid modifier on 59515.
You are then left with either billing E/M or 59430. I think it depends on the services provided. If it was really just a visit for the infection, I lean towards E/M. If your physician provided full postpartum care, then 59430 would be appropriate. Keep in mind this means the primary OB cannot be billing for postpartum.
Per Supercoder, 59430 description:
Typical postpartum care includes ongoing evaluation of the mother’s physical and mental status following birth, a physical examination to ensure that the mother is recovering normally, discussion of lactation, nutrition, and exercise after delivery, review or initiation of birth control options, evaluation of immunizations, and collection of a screening Pap smear specimen if warranted. The first visit can be at four to six weeks following vaginal delivery, but if the patient has a cesarean delivery, the first visit may be seven to fourteen days following delivery and includes minor cesarean wound care. The physical examination should include measuring weight and blood pressure, and an examination of the breasts, abdomen, as well as a pelvic exam. The provider will also incorporate preconceptual counseling into postpartum care, when appropriate, to prepare the patient for a future pregnancy.
If your physician did not provide that service, then E/M.
Hope that helps, and welcome further input by coders who typically bill OB....
 
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csperoni said:
I typically code gyn oncology, not ob, but here's my answer:
59515-80 is off the table as an option, since -80 is not a valid modifier on 59515.
You are then left with either billing E/M or 59430. I think it depends on the services provided. If it was really just a visit for the infection, I lean towards E/M. If your physician provided full postpartum care, then 59430 would be appropriate. Keep in mind this means the primary OB cannot be billing for postpartum.
Per Supercoder, 59430 description:
Typical postpartum care includes ongoing evaluation of the mother’s physical and mental status following birth, a physical examination to ensure that the mother is recovering normally, discussion of lactation, nutrition, and exercise after delivery, review or initiation of birth control options, evaluation of immunizations, and collection of a screening Pap smear specimen if warranted. The first visit can be at four to six weeks following vaginal delivery, but if the patient has a cesarean delivery, the first visit may be seven to fourteen days following delivery and includes minor cesarean wound care. The physical examination should include measuring weight and blood pressure, and an examination of the breasts, abdomen, as well as a pelvic exam. The provider will also incorporate preconceptual counseling into postpartum care, when appropriate, to prepare the patient for a future pregnancy.
If your physician did not provide that service, then E/M.
Hope that helps, and welcome further input by coders who typically bill OB....
Click to expand...
heyy, do you think that an infected csection wound that requires prescription would be separately billable from global package?
 
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VictoriaOlson said:
Hello everyone,

I have a little bit of a dilemma and I'm hoping that someone can help me out. Here is the scenario:

Patient was seen in the hospital for a c-section and my OB assisted. This patient had previously not been seen in our clinic.
Patient then comes to our office a month later with an infection of the c-section site. She attempted to get into her primary OB but due to COVID was unable to be seen.

We have not billed out the delivery as per our state Medicaid guideline our assist claim MUST match the primary surgeon's in regards to diagnosis codes and we are waiting for the other clinic's codes.

My question is which is the most accurate way to bill this? My provider thought it should just be a regular office visit but I disagree. I'm thinking that it should either be postpartum care (59430) or instead of billing 59514 (cesarean delivery only) with modifier 80, bill 59515 (cesarean delivery including postpartum care) with modifier 80.

Any suggestions?
Click to expand...
First, hopefully you state does not insist that you use the same CPT code as your surgeon only provided assistant services on 59514, not 59515 (which includes PP care). Since he seems to have seen the patient only for the complication, that would not be considered normal PP care as described by Christine in her reply to you. So you are billing for the delivery assist independently and for a different date of service (and the delivery Dx codes will match). For the complication, report an E/M service only and use a code that indicates the nature of the complication (which will be an O code). This is not normal PP care so should be excluded from any global care AND you are not the provider of record for the delivery (assisting does not count or rather should not count).
 
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