Saturday, August 31, 2013

OB Coding for a "missed" delivery - what is right? wrong? what do I do?

This seems to be at the forefront of a lot of OB offices. In Idaho (where I reside) these are the scenario's that we utilize the most. However, your facility or practice, may choose something different. There is nothing from ACOG stating what is "right". I have come up with this bulleted list, to view your options. Again, it would depend on your physician practice and/or facility (if MD's are salaried vs/private) Thanks L : ) There are a number of scenario's, but I have reviewed what has been most common that yy readers have inquired aboaut. The "most appropriate" way to do these I've compiled below. (eg that insurance carriers like to see) Scenario A A)If you are the attending(Global OB): Bill the global code (59400) with a mod -52 (for not actually "catching" the baby, or if the RN is the one who has actually "caught" the baby.) When you bill these, be sure to denote that the physician "missed" the delivery of the infant, but completed the balance of care. Also, be sure use the "precipitous delivery" diagnosis driver of 661.31 as our primary dx. Scenario B b) If your provider is the attending and has missed the delivery but the Nurse was in attendance: Bill the Antepartum care only (59425/26), a placenta only delivery(59414) and any vaginal repairs if needed, and post-partum care(59430) once your provider actually see the patient back in the clinic setting/office. Some carriers and 3rd party payers prefer this methodology. If you choose to bill with the above, you may also bill the placenta only delivery with diagnosis code 661.31 for preciptate labor. With ACOG's guidelines, you could then appropriately bill subsequent daily hospital visit codes(99231-99233) for the maternal hospital stay, and also a Discharge (99238-99239) If you truly only provided the "intra-partum" care, and not a full "delivery spectrum" of care. Once the patient arrives in your clinic for a 2/4/6 wk follow up, bill the 59430 post-partum care code. Scenario C c) If an outside physician or OB hospitalist (someone outside your practice or tax ID #)delivers the baby, the placenta & does any repairs, then the outside physician/hospitalist will usually bill the 59409 delivery only code. The PCP/Antepartum OB would only bill the Ante/Posts for that patient, and any other subsequent care during the delivery stay. Scenario D d) If the outside physician or OB hospitalist have a reciprocity agreement, or a Financial agreement of cross/coverage, you could then bill the global feel to the insurance carrier or 3rd party payer as OB/Gyn provider, office. You owuld then provide an outside reimbursement to the actual delivery physician or OB hospitalists service via in-house transfer/or private payment methodology. (eg. $500.00 lump sum to the OB hospitalists for the delivery only) If the hospitalists and the OB's have a reciprocity agreement in place, it would then be inappropriate to bill the OB's for a placenta only delivery and/or repairs. I am sure there are many, many more scenario's and different issues that come up in regard to "missed delivery" billing. If you are unsure, contact all proviers of care involved, and contact the insurance payers/3rd party payers to inquire as to what methodology they would like to see the claims submitted under. L : )

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