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Coding for postpartum hospital stay

Tierni Posted Wed 22nd of January, 2020 14:00:48 PM
Are the postpartum visits done during the hospital stay billable? The coding rules for the delivery codes are a bit confusing stating that it is separate from global charges. However, the code itself 59510/59400 includes postpartum care. Please advise. Thank you
SuperCoder Answered Thu 23rd of January, 2020 02:19:21 AM
>Hi,

>Thanks for your question.

>The postpartum visits done during the hospital stay depends on the services provided during the postopartum period:

 

The services reported separately during the postpartum period are:

  • Treatment and management of complications requiring other services or visits during the postpartum period (eg, gestational diabetes mellitus, hypertension in pregnancy, preterm birth). For example, ordering the 2-hour oral glucose tolerance test for a woman with gestational diabetes mellitus would be included as part of postpartum care. Initiating treatment of newly diagnosed type 2 diabetes with metformin would be a service separately reported.
  • Management of problems unrelated to the pregnancy (eg, hypertension, glucose intolerance, obesity).

>The services that are included in calculating the global reimbursement for obstetric care are:

>•  Routine hospital visits

  • Vaginal delivery; 1 inpatient visit, 1 discharge, 99231, 99238
  • Cesarean delivery; 2 inpatient visits, 1 discharge; 99231, 99232, 99238
>•  Routine office visits during global period

  • Vaginal delivery; 1 office visit, valued as a 99214
  • Cesarean delivery; 2 office visits, 1 valued as a 99213 and 1 valued as a 99214
>•  The postpartum visit should include

  • an interval history
  • a physical examination and Pap test, if needed
  • a review or initiation of birth control methods
  • discussions on breastfeeding, emotional status, counseling for future pregnancies, and any laboratory studies or immunizations appropriate for the specific patient
  • Postpartum counseling for conditions that occurred during pregnancy (ie, glucose tolerance testing in gestational diabetes mellitus, counseling for stillbirth).
  • Note: E/M code 99214 includes in its value, 25 minutes of physician time spent face-to-face with the patient.

>Hope this helps.

>Thanks.

Tierni Posted Thu 23rd of January, 2020 14:06:24 PM
What if the delivery is not the global code(59514, 59409)? Can you code & bill for the hospital stay? If the patient delivered vaginal, can you additionally bill for the 99231 & 99238? Same with c-sect. delivery only, can you bill 99231, 99232, & 99238?
SuperCoder Answered Fri 24th of January, 2020 02:37:03 AM

Hi,

Thanks for your question.

As per the section specific guidelines when reporting delivery only services (59409, 59514, 59612, 59620), report inpatient postdelivery management and discharge services using Evaluation and Management Services codes (99217-99239).

Delivery and postpartum services (59410, 59515, 59614, 59622) include delivery services and all inpatient and outpatient postpartum services. Medical complications of pregnancy (eg, cardiac problems, neurological problems, diabetes, hypertension, toxemia, hyperemesis, preterm labor, premature rupture of membranes, trauma) and medical problems complicating labor and delivery management may require additional resources and may be reported separately.

Hope this helps.

Thanks.

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