Reimbursement Advisor

At-home labor following discharge

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Q We recently had an obstetric patient who was admitted for observation due to upper-quadrant abdominal pain. During her stay, a general surgeon performed a cholecystectomy. She was discharged 6 days after admission, but immediately went into preterm labor, delivering at home at 27 weeks’ gestation. She and the baby were readmitted on the day after her discharge. How do I charge this?

A Did you provide all of the obstetric care except for the delivery? If so, you can bill the global obstetric service, should the payer allow, but should also add modifier -52 to indicate reduced services.

Alternatively, you may want to bill only for those services that were actually performed, by splitting the care into its component parts. This would mean billing for:

  • the antepartum care using 59425 (4 to 6 visits) or 59426 (7 or more visits);
  • the hospital admission after delivery (codes 99221-99223);
  • the delivery of the placenta (code 59414) or an episiotomy (code 59300), if performed after the delivery; and
  • the postpartum care (code 59430).

Note that the American College of Obstetricians and Gynecologists Coding Manual states that code 59430 includes both inpatient and outpatient postpartum care, but start until after delivery of the placenta. This means you can bill the hospital admission, but not the subsequent care or discharge home.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects 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.

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