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Delivery Charges

  1. Exclamation Delivery Charges
    Medical Coding Books
    Our doc did not get to l&d in time for the delivery or for delivery of the placenta but the pt did have a laceration that was repaired by the doc. Does anyone know if/how this can be billed?

  2. #2
    Location
    Kansas City, MO
    Posts
    751
    Default
    You should be able to bill a laceration repair code since he did not perform the delivery. You will have to look at his note to determine which code to use. That is as long as the provider that did the actual delivery was not a member of your group.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  3. Default
    The doc is part of our practice

  4. #4
    Location
    Kansas City, MO
    Posts
    751
    Default
    Then, unless it was a 3rd or 4th degree laceration repair, then there is nothing that can be billed.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  5. Default
    I have a case just like this one - vaginal delivery with 3rd degree laceration. The insurance company (Wellcare) is denying 12042, saying that it's included in the other procedure. Can someone please point towards some ACOG literature or some proof that the code is separately payable, so that we can appeal? Thanks!

  6. #6
    Location
    Kansas City, MO
    Posts
    751
    Default
    Here is the link to ACOG's opinion on laceration repair.

    http://www.acog.org/departments/dept...&bulletin=4645
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  7. Smile
    Thank You So Much Let E Take A Look !!!

  8. #8
    Default
    If none of your docs did the delivery then YES you can charge the repair code or 59300 for episiotomy and hospital visits.
    but you will have to bill out the antepartum & PP care seperatly.
    doc cannot bill for the delivery if they didnt actually deliver.
    the best senerio i can give is the pt delivers at home and comes in to be repaired. so none of our docs delivered.but he/she performs a service and should be paid
    hope this helps.

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