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Need help on disharge from birthing center on next day

  1. Default Need help on disharge from birthing center on next day
    Medical Coding Books
    Hi All,

    We have a denial on CPT 99238 for disharge of new born from a birthing center, stating it was incompatable with the type of service performed. Rep sd they have received the claim with place of service code 25 which denotes the service rendered @ Free Standing Ambulatory Surgical Facility. But as per the actual description it denotes birthing center.

    My questions are, 1)is there any rule that CPT 99238 should be billed with only POS 21,
    2) Is there any other code for discharge from birthing center on some other date.

    Please some one help me on this denial.

    Thanks a lot in advance!!

    Prem Kumar,B.Pharm,CPC

  2. Default
    We bill for many free standing birth centers. They are classified as Ambulatory Surgical Centers, which means it is not considered in-patient. As such, there is no hospital admit or discharge. These services are included in the facility fee.

    If the new mom leaves the birth center the next calandar date, we bill two dates of service for the facility fee, the second date being pro-rated.

  3. Default
    Hi Sugihara,

    Thanx for your reply. What do you mean by second DOS being pro-rated? can I bill same CPT 99460 for the two dates of service initial and the next date?

    Please advice!


  4. #4
    Milwaukee WI
    Default Discharge from observation
    If you are in an outpatient setting, you will need to look at the Discharge from Observation codes.

    F Tessa Bartels, CPC, CEMC

  5. Default
    Hi Bartels,

    Our place of service is birthing center 25.

    Please give me some information on the second day in birthing center (getting discharged on second day).


  6. Default
    Sorry, I was refering to the facility fee being pro-rated, not the newborn care code. We have never been reimbursed for 99460 with POS 25. We always use 99463, which includes the first 24 hours of care. It does create a problem when baby is born at 11:45PM, but it is the best code available. I have spoken to many insurance supervisors about this, and they have (so far) all agreed that 99463 is acceptable, even if baby went home the next calendar date.

    I hope this is helpful.

  7. Default Facility charges for birthing center

    Can you tell me how you bill for the facility charges for the birthing center?
    Last edited by Bmarinelli; 03-12-2014 at 07:13 PM.

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