Delayed delivery codes

wendy7879

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Scurry, TX
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Do most insurances cover E&M codes for patients that are scheduled for an Induction and they do not deliver for 2 to 3 days after they are admitted? Is that included in global? For instance if a patient is admitted for cytotec on 7/10 and the nurse inserts the cervical ripening and the doctor dictates her Antepartum H&P on that day but the patient has a failed induction so we stop the induction and let her rest and she does not deliver until 7/12 if all that included in global fee for delivery or can we bill an E&M with modifier for a failed induction on 7/11 and bill for cytotec (CPT 59200) on 7/10 ?
 
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For that date span that you have indicated in your post, I would not bill out any E/M codes for the reason below:
DOS 7/10 is patient's admission for induction of labor- CPT 59200 is billable outside of global since patient did not deliver that day. No admit charge would be billed.
DOS 7/11 day prior to delivery, if an E/M charge goes out it is likely to be denied being within 24 hours of delivery. If there is documentation to support medical necessity and patient was seen more than 24 hours prior to delivery, it could be appealed.
 

kathyvl74

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Oak Park, IL
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you should bill for admit on 7/10, only 24 hrs prior to delivery is included in global. add modifier 25 so it does not bundle into 59200
 

nielynco

Networker
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84
Location
Guadalupita, NM
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For that date span that you have indicated in your post, I would not bill out any E/M codes for the reason below:
DOS 7/10 is patient's admission for induction of labor- CPT 59200 is billable outside of global since patient did not deliver that day. No admit charge would be billed.
DOS 7/11 day prior to delivery, if an E/M charge goes out it is likely to be denied being within 24 hours of delivery. If there is documentation to support medical necessity and patient was seen more than 24 hours prior to delivery, it could be appealed.
However, note that the nurse, not the MD inserted the laminaria -therefore 59200 is not a billable service.
 
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