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Wiki Inpatient consult w/59514 same day

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AmyLitterell

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East Wenatchee, WA
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I had coded a 99252 -57 with 59514, which an insurance denied as being bundled.
Is this a bundled code? Would Mod 25 be a more appropriate choice to use?
I'm not finding guidelines to help me with this one.

Please & Thank you!:confused:
 
Code 59514

59514-cesarean Delivery:-

Yes It is bundled. The Subsection –Maternity and delivery guideline says: Delivery services include admission to hospital, the admission history and physical examination, management of incomplicated labor,vaginal delivery (with or without epi, with or without forceps) or CESAREAN DELIVERY.

Medical conditions complicating Preg /labor only may require codes from E/M and Medicine in addition to code for Maternity care.

This holds good also for Surgical conditions complicating preg/ labor.
Thank you
 
While routine pre-operative & admission services are indeed included in the global surgical package, your code combination indicates to me that your doc was not the normal OB doc. Was your doc called in for a consult, recommended surgical intervention instead of a vaginal birth, and then asked to do the cesarean by the patient's normal OB doc? If so, I think you can make a case for payment of the 99252. I agree with the 57 modifier if this is the case, and maybe you just need to argue with the insurance carrier's determination by submitting documentation and pointing out that your doc provided a CONSULT and not routine hosp admission. You may not win, but I'd argue it just because that's how I roll... ;-)

If your doc was indeed the normal OB doctor of record, then nevermind, and I agree with preserene.

Becky, CPC
 
Code 59514

Thank you Becky .I appreciate.That is a real great consultation and eye openingto me! Than you and thank you.
 
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