Q Many patients in our practice see their family physician (FP) for prenatal care. Our obstetrician then performs the delivery and inpatient postpartum care, and the FP handles the outpatient postpartum care in the clinic. The dilemma arises when a cesarean delivery is performed and the FP’s office bills 59430, a postpartum care-only code that includes both inpatient and outpatient care. How should the Ob bill for his services?
A Unfortunately, the cesarean delivery-only codes (59514 and 59620 for failed VBAC) do not include any postpartum care, and the cesarean delivery plus postpartum care codes (59515 and 59622) include both inpatient and outpatient postpartum care, per the ACOG Coding Manual. However, in the case you described, you need to communicate to the payer that the postpartum care was divided between the obstetrician and the FP. Otherwise, some payers might deny the service billed by the FP or inquire why the Ob billed for a service not provided.
One way to avoid this dilemma: Bill for the cesarean delivery plus the postpartum care using the code 59515 or 59622 and add the modifier -52; be sure to carefully document which part of the service (i.e., outpatient) was not provided. Then contact the FP’s office and suggest that when they use code 59430, they should add the modifier -52 and explain to the payer which part of the postpartum care (i.e., inpatient) was not performed. That way, both health-care providers should be reimbursed fairly.
This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.