Coding Question: OB Billing


I was reading your “As the Practice Codes” October 2011 issue about OB billing.  I have a mother that delivered on September 22, 2011.  My doctors in the clinic have performed the prenatal and delivery.  The patient had scheduled a PP follow up visit on 11-16-11 but no-showed the visit.  (I typically try to wait until the PP visit has been performed in our clinic to bill out).  Most likely if patient does eventually schedule her PP visit, it would probably be at our clinic but none has been rescheduled.  So I am trying to decide if I would bill the 59400 (total OB care) (even though no outpatient PP follow up care has been performed at this point) or would I bill out antepartum visits (59426) and delivery only (59409) plus E & M codes after delivery (like 99231, 99238).  Just not sure when the patient does not come back in for her PP follow up visit.  What would happen if we bill this out and then several months later comes in for PP follow up visit after we have billed?


As you know, postpartum care includes both inpatient and outpatient services.  The relative value units for the global OB package include one routine office or outpatient postpartum visit, usually but not necessarily performed at 6 weeks postpartum.  Your physician can decide at what point the visit is no longer a routine postpartum visit and becomes a separate service.
Any postdelivery inpatient visits are included in the delivery service codes.
If your physician or group provided four or more antepartum care visits as well as performed the delivery, but did not provide the routine postpartum follow-up, it would be appropriate to bill the antepartum care only code (59425 or 59426) plus the delivery only code (59409, 59514, 59612, or 59620).  If your physician or group provided less than four antepartum visits, you would report the appropriate E/M service code for each of the antepartum visits, plus the delivery only code.
Your practice should consider developing a policy that addresses the reasonable timeframe for routine postpartum follow-up visits, especially with regard to patients who need to be rescheduled or miss their “6-week postpartum” follow-up. The American College of Obstetricians (ACOG) and the Gynecologists Committee on Coding and Nomenclature has stated that up to 12 weeks postpartum it is appropriate to include this visit in the global OB package.   



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