Saturday, March 2, 2013

An unusual "precipitous" delivery...

This week I got the opportunity to hear about a complex case scenario in regard to a precipitous delivery.  These are the cases that don't happen "every day"... but are a reality to many OB/GYN and Hospitalist based coders...  I would like to extend my HEARTFELT THANKS to the blog-site reader that sent this my way.  By sharing, we all get the opportunity to learn and think about new ideas on how to code the "unusual".. 
How should we code this???

Pertinent Info:  Pt is a 37 week twin gestation – breech.  Dr Light has provided all Antenatal care to this point   Patient was enroute to the hospital at aprox 1:30 a.m., but patient's labor was so quick, she subsequently delivered Baby A in her car after her husband parked the car in the  parking lot of the local mini-mart.  Husband dialed 911 after the first baby was delivered by the husband.  In the interim, the ambulance was dispatched.   Baby A was delivered vaginally  - yet breech.  

The ambulance arrived, and patient was loaded into the ambulance for transport.  As she was being transported to the hospital, twin B was delivered in the ambulance by the paramedic.  Baby B was also delivered vaginally and also breech.  Both placenta's were expelled during the ambulance transport.  
 Upon arrival to the hospital, the patient's OB physician,  Dr. Light, was called and arrived at about 2:00 am to evaluate the patient post delivery.   Dr. Light determined that patient will be admitted for 2 days.   He then completed the H&P/admission, He will round on her tomorrow and probably discharge her then, or possibly, the following day.  

Coding Considerations:
Coding Option "A" 
59400 Vaginal Delivery (Complete package "A") Diagnosis 661.3X 651.0X 652.2X 
59409 "B" Delivery Only  
Coding Option #B 
59400.52 Vaginal Delivery w/52 mod (reduced services OB package for "A") Diagnosis 661.3X  651.0x 652.2x 
59409.52 ("B" reduced svce pkg for hosp svces ) 
Coding Option #C 
59426 Antepartum care only 7 or more visits or 59425 Antepartum care 4-6 visits (billed on the last antecare visit) 
99221-99223 - Admission w/code dx 661.3x, 651.0x   652.2x 
99231-99223 - subsequent codes 
99238-99239 - discharge codes  
And code 59430 Postpartum care only - once you see her in your office...  
Coding Option #D 
59899 – Unlisted Procedure maternity care and delivery DX 661.3X 651.0x, 652.2x -  bill this out with all of your ante/hospital/post care and send in the notes...   
The best information that I can suggest is to find out / query the insurance carrier as to how they prefer to have this billed. Bill the scenario based upon how the carrier has informed you. Be sure to include the entire documentation of the precipitous labor and delivery.