Wiki Labor management

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andersont

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Help. This is my second post. I didn't get any responses from my previous post.

What codes would I use for labor management for a patient that we did prenatal care on and ended up having a repeat C section. My provider spent 12 hours of management in the hospital prior to the C section. Another provider performed the C-section and my provider assisted. Thank you
 
Are you providing post partum care or is the other provider? This will be a tricky coding issue because basically ins will consider this global, except for the fact that your provider assisted, and possibly isn't doing the post partum. You might consider asking if the doctors have an agreement for delivering other's patients. If you can't go that way, you will code the antepartum visits, the C-section with 80 with either postpartum care or without. 59620 or 59622 with antepartum visits.
 
labor management

We will be providing post partum. Was thinking of using a standby code 99360. Dr. feels she should be compensated for the 12 hours she was by the patient's side before C-section was decided. Patient was a VBAC
 
I don't think using 99360 is appropriate; also, if the physician was standing by for the 12 hours, why are they the assistant instead of the primary surgeon?

That is the risk of being an OB; the provider provides all services unless there are complications; they are rendering services throughout the entire pregnancy, and labor & delivery; that is part of the global package. The provider is already being paid higher RVU's for the services rendered because the patient is high risk due to trial VBAC. You're challenge will be to get this claim paid. The appropriate way is to bill the 59622 using the 80 modifier for c-section w/ PP and bill out the antepartum visits with 59425 or 59426.

Hope the payer recognizes the situation and pays accordingly; be prepared to fight to get correct payment as they might consider this global and want you to bill 59618.
 
I'm not sure why 59620 isn't being used. My provider doesn't do C-sections so we have to have an OB/GYN doc who does, on standby and my doc assists. I got the codes for the C section from their office. I will talk with their biller and ask about 59620. My provider was there in hopes she would deliver vaginally.
 
In that scenario, I couldn't be sure if you would get reimbursed for the 99360. I think most carriers would say it's included in the global care. Since you aren't billing global care, you can certainly try it and use it as a guide for the next time. Let me know how it turns out, I could always use the experience and knowledge down the road. Good Luck!
 
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