Wiki help w/complicated pre/post c-section


Fallbrook, CA
Best answers
Pt had hypertension/preeclampsia during pregnancy, during delivery she hemorrhaged requiring transfusion had pulmonary edema,toxemia,atelectasis, body systems started shutting down, started to go into CHF, the obg doctor stayed with the patient though the night to carefully monitor her. To care to keep her out of ICU. I'm sure this would NOT be just the normal C-section delivery. Could anyone give me an idea on how to charge this complex delivery. "up and above the regular c-section charge". Possibly "prolonged visit 99356-99357" or "critical care 99291-99292" Thank you so much
It sounds to me like critical care should be considered. Remember, critical care is not dependent on being in the "critical care unit," but is primarily dertermined by the condition of the patient. As long as time is documented (these are "timed" CPTs), you should be able to substantiate critical care. Better to read the "Critical Care Services" notes in CPT for guidance. :)
Some are easy, some are hard

I had a surgeon once say to me, "some are easy, some are hard."
Postoperative care is included in the reimbursement of the surgery. You will not be able to separately code for any of the E/M care provided post surgey - no matter how complicated or difficult this care became. (Critical care IS an E/M code.)

Hope that helps.

F Tessa Bartels, CPC, CEMC

Since this is not normal postoperative care (the patient basically "crashed"), I would go ahead and try for the critical care if the patient was admitted to ICU and if your physician's documentation can meet the requirements for critical care coding. Having said that, in all likelihood, your claim will be denied as global care and you will have to appeal. Be sure you can substantiate your appeal if you and your doctor choose to go this route.