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How to bill for AP, CS assist, Hospital Aftercare, and PP

  1. #1
    Default How to bill for AP, CS assist, Hospital Aftercare, and PP
    Medical Coding Books
    I have a dilemma. One of my OB's as has had multiple of the following situations:

    The patient is seem by my OB for the entirety of the pregnancy (8 visits). Patient ends up having a c-section by another surgeon with assist by my OB. The surgeon does not see the patient in the hospital after the CS-my OB does all hospital follow-up. Patient is then seen for post partem care by my OB.

    Normally, I would say to code this as 59426, 59514-80, 59430. However, since the surgeon is not seeing the patient in the hospital, would I be warrented to attach an additional modifier to the CS denoting my OB did the aftercare? If so, which? I don't think -55 quite fits the bill.

    Any suggestions?

    Barbie Hays, CPC

  2. Default
    The surgeon will have 59510. Your OB would have all those as you said- 59426, 59514-80, and 59430.
    But in my openion there is no need for a modifier for aftercare because the after care is incorporated into the Postpartum care.
    Since the 59430 being a separate procedure, I have yet another school of thought: what if we give 59515-80 for your OB, instead of 59514-80 and 59430;
    Would it be undercoding? however my gut feeling says that your codes justify the correct payment modality.
    Could any one better refine this doubt with oyur experience/

  3. Smile
    Preserene, you can not add a modifier 80 to 59515. Barbie, you are correct in your coding. (59426, 59514-80, 59430.) 59430 would include the routine hospital care as well as the outpt visits to your clinic. The surgeon would bill the delivery only 59514.

  4. #4
    Is the 59430 for the inpatient care? What ICD-9 would you append for a normal PP visit? Would they also have a d/c 99238 or 9? What diangosis would you append to that?

    Do you get to bill another 59430 for the outpatient 6 week f/u visit or is inclusive of the inpatient visit?

    How about the suture removal? If your doc assisted on the c/s, do you code 99024 for the suture removal or bill for an office visit?
    Heidi Thompson, CPC

  5. #5
    Is anyone billing for OB that understands these questions?

    Please help!
    Heidi Thompson, CPC

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