Wiki delivered at home by husband

Create Wiki
J

jebond123

Contributor
Messages
19
Location
Vancouver, WA
Best answers
0
I'm looking for coding advice for a scenario in which we followed our patient throughout her pregnancy. She ended up delivering at home(husband delivered the baby) She was then taken to the hospital by EMT's where my doc delivered the placenta and provided all necessary in-patient follow up care. She will be seen by him for her postpartum care as well. I'm hoping for advice on how to bill for this. My boss wants to bill globally but I don't think we can.
 
jebond123 said:
I'm looking for coding advice for a scenario in which we followed our patient throughout her pregnancy. She ended up delivering at home(husband delivered the baby) She was then taken to the hospital by EMT's where my doc delivered the placenta and provided all necessary in-patient follow up care. She will be seen by him for her postpartum care as well. I'm hoping for advice on how to bill for this. My boss wants to bill globally but I don't think we can.
Click to expand...
You can only bill globally if you report it with a modifier -52 and provide information about the part your MD did not do. As the delivery is represents about 30% of the work you can expect a reduction in payment. However, your payer may have other ideas and not allow global billing under this circumstance. In that case you bill all antepartum care, admission to the hospital, delivery of the placenta, follow-up hospital care and outpatient PP care separately.
 
You will bill all antepartum care, admission to the hospital, delivery of the placenta, follow-up hospital care and outpatient PP care separately.
 
I’m turning to this forum because I’m not sure what else to do. I think my coworker billed a 59400 incorrectly or falsely. Patient keeps calling asking questions that I don’t have the answers for. I have only been in OBGYN for 1.5 years and am not involved in posting hospital visits/ deliveries / surgeries. But my gut says it’s WRONG. Per documentation , the baby was delivered at home by the husband , EMS delivered the placenta, and the doctor of record in the practice performed a 2nd degree perennial laceration repair. This office saw the patient for all antepartum care , but NO postpartum care. Postpartum care was provided by a different office , where her antepartum care doctor transitioned to. The doctor who repaired the laceration did not provide any of the antepartum care. I have been scouring the coding manual for a repair code. But everything I’ve found , researched online stated the 2nd degree lacerations repair are included in delivery. But the doctor did not perform the delivery. Is there a procedure code for this scenario?
 
I think we can all agree that 59400 is wrong in this situation, as delivery was not done by the physician. 59400-52 could be a consideration IF the practice provided the antepartum and postpartum along with the delivery adjacent services provided, but that does not seem to be the case here.
The way your post is worded, it sounds like office 1 provided all antepartum. Dr. B of office 1 performed the laceration repair following delivery. Then Dr. A from office 1 moved to office 2. Dr. A while employed by office 2 provided all postpartum care.
If that is the scenario, then the entire maternity care billing must be split. Unless there are other arrangements in place, each practice bills for the work provided by the clinicians working for them at the time. Likely:
Office 1 59426 for antepartum plus laceration repair. Possibly hospital services as well (visits, discharge, etc.)
Office 2 59430 for postpartum
I know there are some very thorough other posts regarding the billing of the hospital services if needed.
 
lizzyjohnson92 said:
I’m turning to this forum because I’m not sure what else to do. I think my coworker billed a 59400 incorrectly or falsely. Patient keeps calling asking questions that I don’t have the answers for. I have only been in OBGYN for 1.5 years and am not involved in posting hospital visits/ deliveries / surgeries. But my gut says it’s WRONG. Per documentation , the baby was delivered at home by the husband , EMS delivered the placenta, and the doctor of record in the practice performed a 2nd degree perennial laceration repair. This office saw the patient for all antepartum care , but NO postpartum care. Postpartum care was provided by a different office , where her antepartum care doctor transitioned to. The doctor who repaired the laceration did not provide any of the antepartum care. I have been scouring the coding manual for a repair code. But everything I’ve found , researched online stated the 2nd degree lacerations repair are included in delivery. But the doctor did not perform the delivery. Is there a procedure code for this scenario?
Click to expand...
Laceration repair done by a provider when the delivery occurs outside of the hospital can be billed with 59300 (1st and 2nd degree are usually included in the delivery but the delivery happened outside of the hospital in this case). You can also bill for the subsequent inpatient days the patient is in the hospital for.
 
You must log in or register to reply here.
Top