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.
