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OB postpartum in the hospital

  1. #1
    Default OB postpartum in the hospital
    Medical Coding Books
    I need clarification of 59430 when used in the hospital. My understanding is that this code is for PP care when the MD didn't do any of the other care in the hospital. Is that true? I've just been handed some OB inpatient billing and my MD is trying to bill:

    Is this correct or is the 5/18 visit part of the 59409 fee?
    Heidi Thompson, CPC

  2. #2
    Default postpartum care
    The 59430 for postpartum care is for MD office visits. You should use the correct E&M hospital inpatient code for the hospital care after delivery.

  3. #3
    Coastal Coders
    Actually, if your doctor did all of the work, antepartum, delivery, and postpartum, you will bill a global delivery code 59400. This one code encompasses all of the routine prenatal appts, the delivery, and the postpartum care provided both in the hospital and the postpartum visit at the office. You wouldn't bill for subsequent hospital visits for the same reason you don't bill bill subsequent hospital visits or discharge for a surgery: they are included in the global package.

    If your doctor did the delivery only, you will bill 59409 SVD
    If your doctor did the delivery only, but also followed the patient's hospital care and/or postpartum follow up in office, you can bill 59410, SVD w/ PP care

  4. Default
    CPT just clarified this year what is included in the PP care. Per CPT coding guidelines the subsequent hospital visits are not included in the delivery only code (59409 or 59514) and should be reimbursed separately. CPT states “Delivery and postpartum services (59410, 59515, 59614, 59622) include delivery services and all inpatient and outpatient postpartum services.”

    This guideline can be found in the 2011 CPT book at the beginning of the Maternity Care and Delivery section (pg. 300 in the AMA Professional Edition) and states “When reporting delivery only services (59409, 59514, 59612, 59620), report inpatient post delivery management and discharge services using Evaluation and Management Services codes.”

    So I agree with sknapp56 and it would be 5/17-59409, 5/18- 99231-3 (depending on documentation, 5/19-99238.

  5. #5
    For the d/c on 5/19, is V24.2 appropriate to use?
    Heidi Thompson, CPC

  6. #6
    In re-reading, the previous post, would it be correct to code like this? (Using a pt with DMII, uncontrolled)

    5/17-18 59410 for the vag delivery and next day inpatient PP check (648.81, 250.02, V24.2, V27.0)
    5/19 99239? (ICD-9 is the same as 5/17-18?)


    5/17 59409 (648.81, 250.02, V27.0)
    5/18 99232 (648.84, 250.02)
    5/19 99239 (648.84, 250.02)

    What if the patient was uncomplicated:

    5/17 59409 (650, V27.0)
    5/18 99232 (dx?)
    5/19 99238 (dx?)

    I found on EncoderPro that V24.2 is not an acceptable primary dx for inpatient. So, I don't think I'm able to use that for the d/c day. What would be the appropriate diagnosis for d/c?

    One more:

    6/14/11 Admit for pre-eclampsia complicated by asthma and obesity = 99223 (642.43, 649.13, 278.00, 493.90)
    6/16/11 Vag del with severe pre-eclampsia = 59409 (642.51, V27.0)
    6/18/11 D/C = 99239 (dx?)

    Please help me to understand this... there are SO many different scenarios that I really need to understand it so that I can apply it to the different visits.
    Last edited by hthompson; 08-01-2011 at 12:49 PM. Reason: forgot something
    Heidi Thompson, CPC

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