Question Delivery care at two facilities

kstine713

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Hello!

Our office was hoping for some help coding for a bit of a different delivery situation. A patient delivered at one hospital, but then was transferred to another hospital after delivery for her postpartum care due to the baby needing to be admitted to the NICU. How would we bill for this scenario since services were rendered at two different locations? We still provided care for her at both locations. Do we bill antepartum & delivery only at the first facility, and then for postpartum care at the second? Or do we just bill for the whole global delivery at the first location? Or is there another way to report this to the insurance? Any insight you have is very appreciated!

Thank you!
Kaytie
 

kajalgaonkar16

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It would be appropriate if you code antepartum + delivery for the location she delivered the baby. And code postpartum services code for the location where she was transferred after the delivery.
You may not code global delivery code here since as per the definition global delivery includes antepartum care, delivery and postpartum care. And in your case, the postpartum care was provided to the patient at a different location.
You may refer the following claim filing scenarios-
Scenario 1: Maternity care provided by two different physicians in two different unaffiliated groups
Dr. Blue provides only antepartum and/or postpartum patient care and does not perform the delivery. Therefore, Dr. Blue should file the appropriate CPT code(s) for only the antepartum/postpartum care. Dr. Cross, who is unaffiliated with Dr. Blue’s practice, performs the delivery. Therefore, Dr. Cross should file the appropriate CPT code for only the delivery. In this scenario, the prenatal care, labor and delivery, and post-delivery care were provided by two different physicians in two different unaffiliated groups. A global CPT code is not applicable and should not be filed by either physician.

Scenario 2: Maternity care provided by two different physicians practicing at the same location (group)
When two different physicians are practicing at the same location, and both are providing the maternity care (for example, Dr. Blue provides antepartum/postpartum care, and Dr. Cross performs the delivery), a single claim should be filed with the appropriate global maternity CPT code. Two different claims should not be filed since Dr. Blue and Dr. Cross are rendering the maternity care and practice at the same location.
 
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It would be appropriate if you code antepartum + delivery for the location she delivered the baby. And code postpartum services code for the location where she was transferred after the delivery.
You may not code global delivery code here since as per the definition global delivery includes antepartum care, delivery and postpartum care. And in your case, the postpartum care was provided to the patient at a different location.
You may refer the following claim filing scenarios-
Scenario 1: Maternity care provided by two different physicians in two different unaffiliated groups
Dr. Blue provides only antepartum and/or postpartum patient care and does not perform the delivery. Therefore, Dr. Blue should file the appropriate CPT code(s) for only the antepartum/postpartum care. Dr. Cross, who is unaffiliated with Dr. Blue’s practice, performs the delivery. Therefore, Dr. Cross should file the appropriate CPT code for only the delivery. In this scenario, the prenatal care, labor and delivery, and post-delivery care were provided by two different physicians in two different unaffiliated groups. A global CPT code is not applicable and should not be filed by either physician.

Scenario 2: Maternity care provided by two different physicians practicing at the same location (group)
When two different physicians are practicing at the same location, and both are providing the maternity care (for example, Dr. Blue provides antepartum/postpartum care, and Dr. Cross performs the delivery), a single claim should be filed with the appropriate global maternity CPT code. Two different claims should not be filed since Dr. Blue and Dr. Cross are rendering the maternity care and practice at the same location.
For Scenario 2, does it state that anywhere in the CPT coding book? I have looked and am unable to find it. Or where would you get that resource to know to code it that way instead of billing 2 different claims.
 
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For Scenario 2, does it state that anywhere in the CPT coding book? I have looked and am unable to find it. Or where would you get that resource to know to code it that way instead of billing 2 different claims.
 

fwnewbie

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Hi. I looked in the CPT and the first code listed under "Vaginal delivery" is a combination code for all care and delivery. So, if all that care was provided by the physicians in the same group, that is what the group would file. I would think it's up to each practice how they divide the payment. Below 59400 gives individual codes to use for different physicians from different groups depending on the services rendered. Same is for C-section codes. Read all the codes in each section - there are only 8 for vag, 3 for c/s, and 6 for VBACs.
 
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