Delivery W/ no Provider Present

aguelfi

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I have a pt who paid in advance for her c-section, who instead delivered in the hospital vaginally when there was no one in the room but her husband. She was a previous c/s. The ARNP arrived 2 minutes later to deliver the placenta and idid exam for lacerations and such. How do I bill this? The NP is stating that I should still bill a 59400 because she has to be liable and someone has to bill for the delivery, but I think I should only bill for the deliverly of the placenta and post-op visits and the additional tubal the next day and refund her the rest of her money.
What do others think??
 

Anna Weaver

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delivery

I agree with you, I believe it should only be the placenta delivery 59414, but I know other's disagree with this. I just wouldn't feel comfortable charging for something the patient did for herself especially with no one else in the room. Of course the following day procedure should be charged.
 

barbacasec

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What about the ante partum visits? Who is getting paid for those? I agree with you on the delivery and pp and the next day surgery but did she prepay for her ante partum visits? If not you need to charge for those if you aren't billing out for a Global delivery and once you split it all up it may actually cost the patient more money-
 

aguelfi

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I didn't think about the ante visits. She did pay for a global delivery. I understand where it might cost more but how can I bill for somthing that wasn't done....even if it is a self-pay. I'll need something in writing to present to the NP on this one. She's a tuffy.
 

barbacasec

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You need to bill for what is actually done. The Ante partum visits 7 or more is 59426, the delivery of the placenta 59414, the postpartum care 59622 and the pp tubal 58605. That covers everything that was done and if there was no one there for the actual delivery then it should be noted as such in her chart and no one should bill the global. Just make sure you send in the ante partum record with the 59426 and use the last date she was seen in the office for a normal ante visit. Its all about documentation. If it was documented that she delivered on her own you can not bill for the global - just as if the patient delivered in route to the hospital. As for this in writing I am not sure where to send you but like they say "not documented not done"

Hope that helps- good luck
 

beck627

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Have you looked on the ACOG website for any info in writing? It seems this may have been an issue before and maybe they have something you can reference. Just a thought, good luck!
 

aguelfi

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yes and i didn't see anything. I presented it w/ ante care, delivery of placenta, pp care, and tubal. We have to do a small refund to the pt but those are the breaks.
 

Beany011178

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I to have had this question and wrote to ACOG and here is the response that I got copied and pasted. I have a hard time billing for something that was not done but I have saved the email for that reason. Hope this helps.



This is in response to your e-mail of May 30, 2008. You asked about coding for obstetric care when the physician was not present for the delivery. The answer depends on the relationship between the primary obstetrician and the other physician.

ACOG's coding committee has stated that if the physician misses the actual delivery, but is present to deliver the placenta and perform the episiotomy, then it is acceptable to report the global obstetric code. In the case you described, however, the other physician delivered the placenta. In this case, you should report the appropriate antepartum care only code (59425 or 59426) and the postpartum care only code 59430. Any postpartum services provided in the hospital should be reported using E/M codes.

If, however, the other physician has a covering agreement with your physician, then you might be able to report the global code. Attached is a document that describes coding in these circumstances.

Please let us know if we can be of further assistance.

ACOG Coding Staff
The American College of Obstetricians &
Gynecologists (ACOG)
 

aguelfi

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Thanks Jilly

What did you end up doing though? Did you bill for the global? I just can't bring myself to do it. In my case, there was no doctor covering, no doctor was present when she delivered. She was by herself. So really no one is billing for the delivery.
 

Beany011178

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Although I did not like doing it I did bill for the global b/c not only did ACOG say it was ok. I had my supervisor and another coder working in ob/gyn for years that states that is the way she has always done it also. I am with you though it does not feel right. That is why I have saved that email, just in case someone ever comes back I have my documentation . If you want you could always email ACOG yourself and ask the same question and see if you get the same response.
 
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