Wiki Doctor missed the delivery--can global OB be billed?


Waukesha, WI
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Thanks to a precipitous birth, the baby was delived by a resident in a teaching hospital before our physician arrived. However, our physician did deliver the placenta, as well as provide all prenatal & postpartum care.

I do not think that CPT 59400 is billable in this case because the physician wasn't present for the actual delivery. I would code it out as 59426 + 59414 + 59430.

My co-worker is telling me that the global OB code is billable since: 1) a resident in a teaching hospital delivered the baby, and 2) our physician "delivered something."

I haven't found anything to support either position. I'm also not very familiar with the rules for teaching hospitals. Any suggestions? (with supporting references, if available) :)

Hi Jenny,

It would depend on your physician's participation in the birthing process during labor. Per ACOG if your physician was in contact with the floor during the labor and delivery portion, he can still bill for the delivery even if he didn't make it for the actual birth. It is left up to the physician's discretion whether they want to add modifier -52 or not but ACOG does not require it.

However, there are other issues you need to be aware of with the insurance and the teaching physician/reisdent relationship for federal payers on how it should be billed.
We had this same thing happen here but it was the nurse who delievered the baby. I did get in touch with ACOG and they talked all around their self and really didn't give us a answer. But what we did find out was it depends on the insurance. Ours ended up being through Kentucky Medicaid and when we called to talk to them about it, we were told yes we could bill for the delivery for the doctor, because the doctor was on the way. And babies come when babies come. And the doc was there for the placenta and all the before and after care. So we where told it depends on the insurance carrier. Hope this helps.