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Thread: Billing Postpartum Care CPT code 59430

  1. #1

    Default Billing Postpartum Care CPT code 59430

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    My question is, when is it appropriate to bill code 59430? Does the
    doctor have to perform the hospital portion of the postpartum care in
    addition to the postpartum care done in the office in order to bill code
    59430, or can they just perform the office visit postpartum care with
    code 59430. Our doctor's will see a patient for all her prenatal care,
    then she will deliver at a different hospital, then come back to our
    office for her 2 and/or 6 week postpartum check. Can we bill code 59430
    when we didn't perform the hospital portion of the postpartum care?

  2. #2
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    Default

    The ACOG coding manual define this as uncomplicated outpatient visits until six weeks postpartum.

  3. #3

    Default It depends

    I'm in Florida and for commercial insurance postpartum care is included in the delivery, however Medicaid will reimburse 2 visits when med necessary within 90 days following the delivery. If you accept Medicaid, you may want to check your carrier and see if yours reimburses as well.
    adrianne, cpc

  4. #4
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    Greeley, Colorado
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    Question

    Quote Originally Posted by ndrummond View Post
    My question is, when is it appropriate to bill code 59430? Does the
    doctor have to perform the hospital portion of the postpartum care in
    addition to the postpartum care done in the office in order to bill code
    59430, or can they just perform the office visit postpartum care with
    code 59430. Our doctor's will see a patient for all her prenatal care,
    then she will deliver at a different hospital, then come back to our
    office for her 2 and/or 6 week postpartum check. Can we bill code 59430
    when we didn't perform the hospital portion of the postpartum care?
    I have a similar situation. Our FP docs will do antepartum care and it turns out the patient requires a c-section for which they assist. The CFO has told the FP docs to code 59425 or 59426 for the antepartum care, 59514 -80 for the assist on the date of surgery, 59514 -55 for all post-op care, and then at the 6 wk check 59430. Sounds like a bit much to me...any thoughts?
    Lisa Bledsoe, CPC, CPMA

  5. #5

    Default

    I assume you are using the 55mod for co-management....do you have all of the co-management agreements in place? If you charge for the post-op care 59514-55, this includes the 6 wk post-check as well. I think you may be double billing for this ck. Why wouldn't you use 59510, this includes the antepartum and postpartum care but dnot the delivery, then you could bill if you assist in the c-section. Why are you assisting?
    adrianne, cpc

  6. #6

    Default sorry

    sorry my last post was for Lisa.
    adrianne, cpc

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    Unhappy

    Quote Originally Posted by abenson View Post
    I assume you are using the 55mod for co-management....do you have all of the co-management agreements in place? If you charge for the post-op care 59514-55, this includes the 6 wk post-check as well. I think you may be double billing for this ck. Why wouldn't you use 59510, this includes the antepartum and postpartum care but dnot the delivery, then you could bill if you assist in the c-section. Why are you assisting?
    For one, I was not even consulted on this scenario (being the coder you'd think my input would be requested...). Anyway, the PCP (FP) does all of the antepartum care, the pt is unable to have a vaginal delivery (for whatever reason...and we are assuming up until this point she will deliver vaginally); the OB/GYN (not part of our practice) is called in for the C-Section and the PCP assists. The CFO has instructed the PCP's that at this time they should code out the anterpartum (59425 or 59426), 59514-80 (for C/S only assist); there is an agreement with the OB's that our docs will do all of the post-op care (barring complications)...so the CFO has told the PCP's to also bill 59514-55 at the 2 wk post-op ck; THEN at the 6 wk ck 59430. Again, I think this is too much post-op coding. I think 59514-55 will dup-out with 59514-80...and with mod -55 that is supposed to cover all of the post op care, right? Does that INCLUDE the 6 wk post partum visit? I don't know...I've run this over in my mind so much that I have myself confused. I don't want to go to the CFO until I am SURE of myself. Any help anyone offers is greatly appreciated!!!!
    Lisa Bledsoe, CPC, CPMA

  8. #8

    Default

    don't you hate it when they don't include you but you get to clean up the mess....?
    Modifier 55 is a co-managed modifer and this doesn't really sound like a co-managed case because it isn't planned that way. It sounds like an assist. I still don't think you should use 59514 because that isn't all you're doing. If you bill the prenatal and postpartum and cesarean separaely then you are unbundling the charges and there is a code that covers all of this. This is how I would do it. 59510-80. and NOT bill for any other postpartum care, you are already getting paid for it. It's included in the c-section for most carriers.
    adrianne, cpc

  9. #9
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    Default

    Adrianne - thanks for the help. I've done some more "research" and found that mod -55 isn't even reportable with any of the c-section codes! I'm going to suggest we code the appropriate antepartum code, 59514-80 for the c/s only assist, 99024 at the 2 wk post op ck, and 59430 for 6wk pp. With the -80, we only get reimbursed for the assist on the c/s only, so I feel pretty confident coding the 59430 at the 6 wk ck. Technically, we do have to unbundle the services since we are not providing the complete "package". I appreciate your helping me "think this through"!
    Lisa Bledsoe, CPC, CPMA

  10. #10

    Smile

    I can see how that makes sense....definately one to think about. I have this very problem w/ Midwives assisting on a c-section for a different doc then mine. I'm still not convinced about that second postpartum check though, but that's why we have these forums, to discuss these issues. Thanks Lisa!
    adrianne, cpc

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