Wiki Postpartum only 59430

Create Wiki Sort by date
A

AprilG9476

New
Messages
5
Location
Prosser, WA
Best answers
0
I have a family practice physician in a hospital owned clinic who does ob/gyn care. He saw a patient 4 weeks after her c-section, and wants to code 59430 in addition to 99213. He did not perform the delivery. Is that allowed ever? If so, please help me find a link to the information stating that so that I can justify coding it that way.
Thanks in advance for your help.
 
1
SWall said:
I wasn't really trained on OBGYN just trying to learn from the denials which have been challenging. I'm afraid I may haven't some claims out incorrectly due to lack of education on my side and others.

My question is should I be coding prenatal visits per the insurance carrier policy OR by the codes in the CPT book, OBGYN book?
Click to expand...
If you have payer instructions, dated and in writing, you would follow those instructions or you will get a denial. It means they have ignored the official advice on how to code which would be the CPT book. The CPT instructions will probably change in 2027 so keep an eye out. But always be sure you have the latest coding instruction from your payers to avoid unnecessary denials.
 
0
It is possible that 59430 is appropriate. Here is additional information about the code:
Clinical Responsibility
Typical postpartum care includes ongoing evaluation of the mother’s physical and mental status following birth, a physical examination to ensure that the mother is recovering normally, discussion of lactation, nutrition, and exercise after delivery, review or initiation of birth control options, evaluation of immunizations, and collection of a screening Pap smear specimen if warranted. The first visit can be at four to six weeks following vaginal delivery, but if the patient has a cesarean delivery, the first visit may be seven to fourteen days following delivery and includes minor cesarean wound care. The physical examination should include measuring weight and blood pressure, and an examination of the breasts, abdomen, as well as a pelvic exam. The provider will also incorporate preconceptual counseling into postpartum care, when appropriate, to prepare the patient for a future pregnancy.

If that accurately describes the service your clinician provided, then 59430 should be coded. 59430 would be in place of 99213, unless there was an unrelated visit as well (ie - pt seen for sprained ankle, and also postpartum care.) 99213 is a column 2 CCI edit with 59430.

Another caveat is that the delivering physician should not have billed global for the delivery, which would include postpartum care.

Side note: in my suburban/urban area, it would be unheard of for a family practice clinician to provide postpartum care, but could be more common in rural areas.
 
0
It is rural here. It is not unheard of for family practice docs to get ob/gyn certified. I will need to research whether the delivering physician coded for global. The only problem the patient was having was back pain/sciatica probably from her epidural for the emergency c-section. So it's not likely codable as a separate issue.
Thank you for your help.
 
0
Hello, I have a question regarding 59430. How many times can I code it if pt keeps coming for postpartum(PP)visits? My situation is: MD billed only for the Delivery, now other MD from the same practice is seeing the pt for PP or let's say my MD didn't bill for the Delivery and now seeing pt for PP only.
DOS: 11/15/20- should I bill 59430 (all services described above were provided for PP)?
DOS: 11/30/20- should I bill again 59430?
DOS: 12/15/20- another 59430 or E/M (no other medical conditions are discussed)? How many times can I code 59430? Plus, if I bill today for today's PP visit, I don't know if the pt will come back for a follow-up PP visits.
Thank you, guys! And Happy New 2021 Year!
 
0
59430 gets billed once per patient (if not billed global) for all postpartum care. Please note from above: Typical postpartum care includes ONGOING EVALUATION.... It can be one or more visits. If you're more familiar with global surgical periods, try to think of it as billing for post-surgical care (global period). Whether the patient comes 2 times, or 5 times (unless there is a return to the OR) for postop care, it is all included. You can only separately bill for unrelated visits.
If the same group practice is providing delivery and postpartum, you should be looking at global codes (unless carrier wants it split billed) like 59410 (vag delivery and PP), 59400 (vag delivery, AP and PP), 59510 (CS delivery, AP and PP), 59515 (CS delivery and PP).
 
0
natashalage said:
Hello, I have a question regarding 59430. How many times can I code it if pt keeps coming for postpartum(PP)visits? My situation is: MD billed only for the Delivery, now other MD from the same practice is seeing the pt for PP or let's say my MD didn't bill for the Delivery and now seeing pt for PP only.
DOS: 11/15/20- should I bill 59430 (all services described above were provided for PP)?
DOS: 11/30/20- should I bill again 59430?
DOS: 12/15/20- another 59430 or E/M (no other medical conditions are discussed)? How many times can I code 59430? Plus, if I bill today for today's PP visit, I don't know if the pt will come back for a follow-up PP visits.
Thank you, guys! And Happy New 2021 Year!
Click to expand...
You can only bill 59430 once during the post partum period, assuming that the global was not billed for the delivery. May I ask why the MD only billed for delivery only and not the whole package? It seems as though the service was unbundled seeing as though both providers are in the same practice and -what I assume- they are under the same specialty/subspecialty under the same TIN. If that is the case, I would re-evaluate the delivery coding and look into utilizing 59400/59510 global codes for the delivery. These codes include antepartum care, delivery and post partum care. If the same provider group provided approximately 13 antepartum visits, delivered the baby and has provided the post partum care, it is inappropriate to bill for the 59430 separately. Please note the description indicates "ROUTINE obstetric care".
Per ACOG guidelines, patients are entitled to 1 pp visit for SVD and 2 pp visits for C-section for an UNCOMPLICATED, routine post partum care. If the patient is coming in for issues, the visits are separately reportable with 24 modifier using a standard E/M code assuming the visits are "medically necessary"- for example- infection, post partum depression, blood pressure checks to monitor for PP pre-eclampsia. I would also re-check the documentation for the 11/15/20, 11/30/20 and 12/15/20 visits to make sure there wasn't really problem the patient came in for.

Please read this ACOG article that explains this:

Billing for Care after the Initial Outpatient Postpartum Visit: The Fourth Trimester

The American Rescue Plan Act, signed into law on March 11, 2021, makes available a new pathway states can use to extend Medicaid coverage for pregnant people to one year postpartum.
www.acog.org www.acog.org
 
0
AprilG9476 said:
I have a family practice physician in a hospital owned clinic who does ob/gyn care. He saw a patient 4 weeks after her c-section, and wants to code 59430 in addition to 99213. He did not perform the delivery. Is that allowed ever? If so, please help me find a link to the information stating that so that I can justify coding it that way.
Thanks in advance for your help.
Click to expand...
*Assuming the provider who performed the c-section is not in the same group as your provider*
If the patient is receiving post partum care from the delivering provider, it would be inappropriate for your provider to bill for the 59430. If the delivering provider is NOT overseeing the patient's post partum care, and your provider has taken over the post partum patient care, then it would be appropriate to bill for the 59430.
As far as if this is allowed ever, I would say, yes, depending on the circumstances. The coding software we use shows that the 99213 and 59430 would hit for CCI edit, but a modifier is allowed to override the edit. I would imagine if your provider is taking over the PP care for this patient and the patient came in with -let's say- a broken finger as well, that would be an acceptable reason to bill for both codes as long as the notes can support the 2 separate visits.
 
0
hello,
related to this i have a patient who wasn't our patient but we delivered her so i charged vag delivery only code and she was just see for this post partum follow up with us, see visit description below, she plans to have her regular 6 week pp visit with the other provider that she received antepartum care from. Do i charge a regular e/m for this or do i charge 59430. I assume regular e/m because it's not multiple routine care visits and the other practice will be charging the 59430 when she comes in for her regular 6 week visit

38 y.o.G3P1112 s/p precipitous preterm vaginal delivery here for postpartum follow up from endometritis/hypertension. She was readmitted PPD 6 for endometritis and treated with IV abx. She had some mildly elevated Bps on admission and was discharged on Labetalol 200 mg BID. She reports blood pressure at home with automatic cuff have been mildly elevated. In clinic today normotensive. Plan to continue Labetalol 200mg BID.
She reports no abdominal tenderness. Some pelvic floor soreness. Denies dysuria. Lochia light. Breastfeeding going well. She does have a hemorrhoid which is very tender. Has been using aloe and witch hazel. Proctofoam sent. Reviewed Sitz baths.
Discussed s/sx of hyper/hypotension,
 
0
Korbc said:
hello,
related to this i have a patient who wasn't our patient but we delivered her so i charged vag delivery only code and she was just see for this post partum follow up with us, see visit description below, she plans to have her regular 6 week pp visit with the other provider that she received antepartum care from. Do i charge a regular e/m for this or do i charge 59430. I assume regular e/m because it's not multiple routine care visits and the other practice will be charging the 59430 when she comes in for her regular 6 week visit

38 y.o.G3P1112 s/p precipitous preterm vaginal delivery here for postpartum follow up from endometritis/hypertension. She was readmitted PPD 6 for endometritis and treated with IV abx. She had some mildly elevated Bps on admission and was discharged on Labetalol 200 mg BID. She reports blood pressure at home with automatic cuff have been mildly elevated. In clinic today normotensive. Plan to continue Labetalol 200mg BID.
She reports no abdominal tenderness. Some pelvic floor soreness. Denies dysuria. Lochia light. Breastfeeding going well. She does have a hemorrhoid which is very tender. Has been using aloe and witch hazel. Proctofoam sent. Reviewed Sitz baths.
Discussed s/sx of hyper/hypotension,
Click to expand...
It appears this is not a PP visit for the delivery, but rather for endometritis/hypertension. I would say you should not bill 59430 for this as it is not routine PP care. The payer may or may not agree. But as he did the actual delivery and billed for it, you may be required to add a modifier -24 to the E/M code
 
0
I wasn't really trained on OBGYN just trying to learn from the denials which have been challenging. I'm afraid I may haven't some claims out incorrectly due to lack of education on my side and others.

My question is should I be coding prenatal visits per the insurance carrier policy OR by the codes in the CPT book, OBGYN book?
 
You must log in or register to reply here.
Top