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OB experts! Need some examples!

  1. #1
    Default OB experts! Need some examples!
    Medical Coding Books
    I need to find out when it would be appropriate to allow my OB inpatient providers to bill for the Initial or Subsequent Hospital Care for a patient who has delivered. I've made an OB superbill and it has charges for delivery, inital/subsequent hospital care, d/c, observation with d/c same day and newborn care. I'm trying to accurately explain when the hospital inpatient codes are appropriate and I'm not sure of the answer.

    I've been allowing their use when pt comes in for a complication of pregnancy and doesn't deliver, but what if they came in for oligohydramnios and were induced? Does that allow for a 99221-99223 for the date of admit? Is that complication serious enough for inpatient hospital codes?

    What if a patient is admitted for labor/delivery and we charge 59409 and the dr wants to bill a 99232 or 99233 for any subsequent visits? What kind of complications are serious enough to allow this?

    A 2nd, 3rd or 4th degree perineal laceration? Anemia? Pitocin induction for post dates?

    Can you list some specific examples that would be appropriate? For most patients, I realize that it's only appropriate to bill for the delivery and no previous or subsequent hospital visits; however, I also realize that some patients will not fall into this "norm" and I really want to understand which patients they are.

    Thanks in advance!!
    Heidi Thompson, CPC

  2. #2
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    Just got another example to see if we can bill inpatient charges...

    Our MD assisted on a c/s. We are billing 59514-80 for that. The primary MD is out of another facility, not ours. Our MD provides the f/u care for 3 days post surgery. Can we bill the 99231 for those 3 days?
    Heidi Thompson, CPC

  3. #3
    Location
    Tacoma, WA
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    Quote Originally Posted by hthompson View Post
    I need to find out when it would be appropriate to allow my OB inpatient providers to bill for the Initial or Subsequent Hospital Care for a patient who has delivered. I've made an OB superbill and it has charges for delivery, inital/subsequent hospital care, d/c, observation with d/c same day and newborn care. I'm trying to accurately explain when the hospital inpatient codes are appropriate and I'm not sure of the answer.

    I've been allowing their use when pt comes in for a complication of pregnancy and doesn't deliver, but what if they came in for oligohydramnios and were induced? Does that allow for a 99221-99223 for the date of admit? Is that complication serious enough for inpatient hospital codes?

    What if a patient is admitted for labor/delivery and we charge 59409 and the dr wants to bill a 99232 or 99233 for any subsequent visits? What kind of complications are serious enough to allow this?

    A 2nd, 3rd or 4th degree perineal laceration? Anemia? Pitocin induction for post dates?

    Can you list some specific examples that would be appropriate? For most patients, I realize that it's only appropriate to bill for the delivery and no previous or subsequent hospital visits; however, I also realize that some patients will not fall into this "norm" and I really want to understand which patients they are.

    Thanks in advance!!
    Since your providers are Inpatient providers, then I assume they are not providing any of the prenatal care.

    DELIVERY INCLUDES: Admission history, Admission to hospital, Artificial rupture of membranes, Management of uncomplicated labor, Physical exam, Vaginal (with or without forceps or episitomy) or C-section delivery.

    **If a patient is admitted for a complication, but does not deliver, you can use the inpatient E/M codes. (See list of conditions under the EXCLUDES) If they are admitted and subsequently deliver, that will be included in the delivery code.

    **If a patient is admitted for induction, that is included in the delivery code.

    EXCLUDES: Medical complications of pregnancy:

    - Cardiac problems

    - Diabetes

    - Hyperemesis

    - Hypertension

    - Neurological problems

    - Premature rupture of membranes

    - Pre-term labor

    - Toxemia

    If they provide any of the in hospital post partum care after the delivery, they should be using the delivery w/post partum care codes (59410 or 59515) as they include reimbusement for that work. For perineal lacerations, if they require extensive repair, then you can bill the repair code, otherwise simple repairs are included in the work for the delivery code.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
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    Quote Originally Posted by hthompson View Post
    Just got another example to see if we can bill inpatient charges...

    Our MD assisted on a c/s. We are billing 59514-80 for that. The primary MD is out of another facility, not ours. Our MD provides the f/u care for 3 days post surgery. Can we bill the 99231 for those 3 days?
    In this case, you may be able to bill the post surgical care since your provider was the assist on the procedure and not the primary.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
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    Do you agree with the inpatient codes for the above scenarios in my OP?

    Specfically admission WITH delivery BUT with a listed complication?

    and delivery with a listed post delivery complication... Are they eligible for a subsequent hospital visit code?

    They are also providing the prenatal care; however, we are a special tribal provider and are allowed to bill for outpatient visits at our contracted rate. That is why we have to bill for the inpatient delieveries as if they did NOT provide the prenatal or postpartum. Its abnormal, I know, that's why I didn't mention it. We do not bill for global unless it's private insurance.

    That brings up a question about global deliveries with complications. How do you bill for the complications? Still the appropriate inpatient codes along with the delivery as long as I have the appropriate diagnoses?
    Heidi Thompson, CPC

  6. #6
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    Quote Originally Posted by ajs View Post
    In this case, you may be able to bill the post surgical care since your provider was the assist on the procedure and not the primary.
    Can you provide the codes you are referring to?
    Heidi Thompson, CPC

  7. #7
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by hthompson View Post
    Do you agree with the inpatient codes for the above scenarios in my OP?

    Specfically admission WITH delivery BUT with a listed complication?

    and delivery with a listed post delivery complication... Are they eligible for a subsequent hospital visit code?

    They are also providing the prenatal care; however, we are a special tribal provider and are allowed to bill for outpatient visits at our contracted rate. That is why we have to bill for the inpatient delieveries as if they did NOT provide the prenatal or postpartum. Its abnormal, I know, that's why I didn't mention it. We do not bill for global unless it's private insurance.

    That brings up a question about global deliveries with complications. How do you bill for the complications? Still the appropriate inpatient codes along with the delivery as long as I have the appropriate diagnoses?

    That is a whole different scenario then. I really am not sure how things should be billed when you have that situation as that does not follow the CPT guidelines for billing OB care and complications. You may need to get more clarification from the office that pays the claims.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  8. #8
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    The guidelines are as you originally thought, so if my providers were only inpatient providers, how would you guide me?
    Heidi Thompson, CPC

  9. #9
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    For my practice, if we did not see the patient for outpatient post partum care, then I will be the inpatient postpartum care as an E/M (99231/99232) with a diagnosis code of V24.0 If the patient had a complication, then I would bill it out with the complication diagnosis codes.
    Last edited by nrodecker; 01-17-2012 at 08:14 AM.

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