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Wiki Delivery with delivery of placenta in OR

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mllivers

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I am getting a denial back that I cannot code the 59400 with the 59414 code. I put a 59 modifier on it but that did not work so I used 78 modifier and it still did not work. Can someone give me some guidance on how to correct this?

Thank you
 
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I haven't billed OB in a while but delivery of the placenta is included in the global charge of 59400. Its considered part of delivery. The only time I could see billing out delivery of placenta would be if there was a problem like retained placenta, but that is usually performed as a D&C or D&E (not sure if curretage or evacuation).
 
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ccallycat said:
I haven't billed OB in a while but delivery of the placenta is included in the global charge of 59400. Its considered part of delivery. The only time I could see billing out delivery of placenta would be if there was a problem like retained placenta, but that is usually performed as a D&C or D&E (not sure if curretage or evacuation).
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Could I put modifier 22 with the 59400?
 
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Nope, that doesnt qualify 22.

So the patient had vaginal delivery, but then had to go to OR for delivery of placenta. To me it seems like the placenta was retained and couldnt be delivered normally (i read it has to be delivered in certain amount of time) so they had to go to OR. Usually going to the OR they would have to do dilation and curettage procedure, just verify that terminology on op report. I would do corrected claim and bill 59400 and 59160-59 (post partum curettage) this code fell under procedures of uterus prior to/after delivery.
 
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I am a new to OBGYN. I would agree with ccallycat post to bill 59400-global and 59160 but with a modifier -78- return to OR. Second scenario:59400-22 could be possible but 59160 is better describes the case. We have Ms. Nielynco in OGBYN forum who has a vast experience in OB coding. She checks periodically our posts and I hope she will add more clarity for us. Have a great day. :)
 
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We don't know what the op note says. Often the placenta is manually removed in the OR. It is not necessarily a curettage. If the same provider did the delivery and removed the placenta manually, you can't bill anything extra. If a CNM did the delivery and an MD removed the placenta, our process is a 22 on the delivery and they do some kind of credit behind the scenes to compensate the MD. Also if the two procedures are on the same day (delivery and curettage), then 78 is not really applicable, and you would use 59. From what I have noticed 59160 usually gets denied though.
 
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mllivers said:
Could I put modifier 22 with the 59400?
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So all of the answers are valid, but the point is we really need more information. First, the delivery of the placenta is included in all the delivery codes so it would have to be something unusual for the delivering provider to be able to bill for it separately. As was mentioned, this possibly could have been the removal of retained placenta (59160) or it could have been a manual removal when it did not delivery promptly. Manual removal would be included, scraping to removed retained products would not be.
 
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ccallycat said:
Nope, that doesnt qualify 22.

So the patient had vaginal delivery, but then had to go to OR for delivery of placenta. To me it seems like the placenta was retained and couldnt be delivered normally (i read it has to be delivered in certain amount of time) so they had to go to OR. Usually going to the OR they would have to do dilation and curettage procedure, just verify that terminology on op report. I would do corrected claim and bill 59400 and 59160-59 (post partum curettage) this code fell under procedures of uterus prior to/after delivery.
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Thank you! Coding the exact case currently.
 
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Hello,
I have a case when MD did a manual sweep right after a delivery. Does it qualify for 59160 (with US 76998)? So much looking forward to your advice. Thank you!
"Neonate's head delivered in the DOA position, followed by anterior shoulder, posterior shoulder, and body without difficulty. There was no nuchal cord. Active management of the third stage was initiated and placenta was delivered. Trailing membranes were observed and removed with ring forceps. US at bedside showed retained membranes and clots. Patient was verbally consented for a manual removal of retained products. 4 manual sweeps were performed with removal of small clots and membranes. US at bedside post removal showed a thin endometrial stripe and bleeding was well controlled with uterine massages. "
 
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natashalage said:
Hello,
I have a case when MD did a manual sweep right after a delivery. Does it qualify for 59160 (with US 76998)? So much looking forward to your advice. Thank you!
"Neonate's head delivered in the DOA position, followed by anterior shoulder, posterior shoulder, and body without difficulty. There was no nuchal cord. Active management of the third stage was initiated and placenta was delivered. Trailing membranes were observed and removed with ring forceps. US at bedside showed retained membranes and clots. Patient was verbally consented for a manual removal of retained products. 4 manual sweeps were performed with removal of small clots and membranes. US at bedside post removal showed a thin endometrial stripe and bleeding was well controlled with uterine massages. "
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No 59160 would not be correct for this. You might be able to add a modifier-22 to the delivery code or just bill for the ultrasound (but it does not sound like ultrasound guidance and assuming they documented the findings) in addition to the delivery.
 
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