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. 

"Welcome to Medicare" - What you need to know.

I came across this article information from a website called "Manage my Practice"  

http://www.managemypractice.com/why-you-cant-get-an-annual-medicare-physical/#more-13471

This is a brief exerpt from the article, but it clearly outlines what we need to understand as Coders for our Medicare patient's in our practice.  This has really cleared up the confusion for me, and hopefully will help you...  help your patients to understand what CMS Medicare will and will not pay for.  and as always... Happy Coding!





".....The only answer is to help patients understand what Medicare will and will not pay for and to try to match their benefits, their needs and what they are willing to pay for.
Here are the service choices defined by CMS/Medicare: "

NAME: Welcome to Medicare Visit

WHEN: Available to all Medicare patients during the first 12 months of Medicare Part B eligibility
WHAT HAPPENS: Review of patient’s medical history, risk factors, functional abilities and referrals for education or counseling. Could include an EKG or referral for an EKG. Could include screening for an
abdominal aortic aneurysm (AAA). Does not include a physical exam.
WHO PAYS: This visit has no deductible and no co-insurance, unless the patient has a screening EKG. The EKG does have the deductible and co-insurance applied.

NAME: Annual Wellness Visit

WHEN: Available 12 months after the Welcome to Medicare Visit and every 12 months thereafter
Does not include a physical exam.
WHAT HAPPENS: Review of your medical history, risk factors, functional abilities, a depression screening and a written screening schedule.
WHO PAYS WHAT: This visit has no deductible and no co-insurance.

NAME: Sick Visit (standard office visit)

WHEN: No restrictions on how often as long as there is a documented need for the visit.
WHAT HAPPENS: This is a regular office visit for an illness, injury or new problem or for monitoring of an existing problem. The three parts of a standard office visit are the HISTORY, the PHYSICAL EXAM, and the ASSESSMENT/PLAN.
WHO PAYS WHAT: This visit will apply to the deductible ($147 for 2013) if the patient’s deductible has not been met, and co-insurance will apply.




The only answer is to help patients understand what Medicare will and will not pay for and to try to match their benefits, their needs and what they are willing to pay for.
Here are the service choices defined by CMS/Medicare:

HCPCS Changes in Depo Provera Coding for 2013

New HCPCS code: 
J1050  (Injection, medroxyprogesterone acetate, 1 mg)

Deleted codes: (as of December 31, 2012)
J1051 (Injection, medroxyprogesterone acetate, 50 mg), 
J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and 
J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg) 


Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-
Provera) should be reported using HCPCS code J1050 . Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient.


This change means that you will code/bill the HCPCS code as J1050 x the amount units given.  (eg.  If the provider is giving 50 units then you should code as: J1050 x 50 units.  If the provider is giving 150 units then you should code as J1050 x 150 units.)  The appropriate diagnosis also needs appended to the claim.  If the provider is giving the drug for a diagnosis such as menorrhagia,  abnormal menstrual bleeding, or other gynecologic reason, the code J1050 should be reported using the exact amount of drug used per patient.  

Medical necessity should always be the driving factor for any therapy given and all orders and  documentation must be noted.

In addition, you will need to report the injection administration with CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, CPT code 96372 requires direct supervision of a physician or other qualified health care professional (unless administered in a hospital setting)