You cannot bill any rounds/discharge if you are billing the global delivery until day 4. If the physician had to take the patient to the operating room for the manual extraction of the placenta you may be able to get 59414 with modifier 58, but you will probably have to fight with the payer. As for the management of the hemorrhage, as i have heard at every ACOG conference i have attended "some are easy, some are hard" but unfortunatley its all global.
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