Sunday, October 10, 2010

OB lacerations - New rules from ACOG & Placenta delivery only's

Well... just when you think you've got the world by the tail... someone changes the rules, and the world whirls around and bites you!!!

with this said... I was working on an appeal for payment of a 3rd degree laceration code that was performed at the time of a delivery. However...... in my research I found out that ACOG (American Congress of Obstetricians & Gynecologists) has bundled 3rd and 4th degree lacerations into the regular delivery code, but you are to append the modifier 22. (Effective as of Jan 1 2010)

My suggestions for getting this paid with the mod 22 attached is to ensure that the documentation from the provider states that the laceration is a 3rd or 4th degree, and clearly states the repair. If possible, have the provider also document the time it took to do this repair, over and above a 1st or 2nd degree repair. (which is also bundled into the delivery, but not separately payable).

So - If you are having the headache of not getting paid for those pesky lacerations.. ACOG put this out in their 2010 ACOG coding manual. If you need or want more info regarding this, please let me know or contact the ACOG for more info. As we all say... we learn more from our mistakes and failures, than we do from our successes. This was a great learning experience for me, so I'm glad to share with you!

Also... I had a situation come up this week, where the OB hospitalist arrived as the baby was being delivered by the nursing staff... and we debated whether or not to bill for a "precipitous delivery" or a "placenta delivery" only.

After much debate, we decided upon the "placenta delivery" only. That way, the OB hospitalists could get paid for the work they performed, and the antepartum care and the postpartum care would be billed by the OB that provided that service.

So what I learned from this last week... is you just never quit learning!!! PS... new ICD-9 codes were effective as of 10.01.2010... so be sure to review the new codes and put them into practice.

... Happy Coding.......... L : )