Coding

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late transfer of care.

  • 1.  late transfer of care.

    Posted 02-24-2020 13:34
    So recently we had an 32 week transfer to our office, patient had a primary c-section delivery, my question is how do I bill her delivery? Would I just bill the delivery and postpartum care, however how would I bill her previous visits ?

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    David PRINCIPE
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  • 2.  RE: late transfer of care.

    Posted 02-24-2020 20:07
    Hi David,
    The straightforward method is for you to bill for the delivery+postpartum as well as for the individual visits you performed. The referring provider would bill for the prenatal visits he/she performed. Alternatively, in some markets, it may be advantageous to bill global, or global billing may be mandated by the payer. You would then bill global and reimburse the referring provider for the prenatal visits they performed. This is only possible if you have a written agreement with the referring provider on those details.

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    Fadi Bsat, MD
    Past Chair, SMFM Coding Committee
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  • 3.  RE: late transfer of care.

    Posted 02-25-2020 05:07
    Hi David
    thanks for posting this question. we answered something very similar recently on the Q&A section of our website:

    Coding Q&A: Question #2096

    My MFM practice conduct deliveries on those whom would like us to be their primary OB physician as well. We currently bill office visits throughout their pregnancy because of the High Risk issues and coordination and care. When it comes to deliveries are we able to bill for the global surgical package codes since we are their ONLY OB providers that has monitored them? Or should we stick to billing deliveries with postpartum care only?

    Answer:

    This is not a simple answer given the various intricacies of shared billing/shared care models.  There are many iterations of care that MFMs provide that do not fit the traditional global ob care packages.  If the MFM provides ALL the obstetric care (antepartum, delivery, postpartum) then billing a global fee is appropriate.  With global billing, any E/M visits beyond the standard number of visits allotted in the global code by that payer (typically 13 visits but may vary) would then be reported separately using the diagnosis(es) that necessitated the additional visits. It would be duplicate billing to report routine antepartum E/M services separately and also report the global code.  

    In general, most MFM groups do NOT bill global services based on the pathway of referral into their practice.  They are NOT performing all the care.  It becomes particularly complicated when some of the care is provided by the Ob provider and some of the care by an MFM provider: 

    a) One option is to bill global and split the revenue internally after the fact - this may work if you are an MFM who works in a group or shared group model with OBs.

    b) In situations where the general ob provider reports some of the antepartum care (and NO delivery) they would report the appropriate antepartum care only code; and the MFM would report the appropriate antepartum care only code for their portion and then in addition they would add the delivery and postpartum care code (59425/59426) In this scenario no one is billing a global fee.

    c) MFM's may also opt to bill directly and separately for their services (Fee for Service). It is important to emphasize that this is very payer/contract dependent.  The landscape has changed dramatically over the last decade.  Traditionally, the SMFM Coding committee has favored E/M billing, but we acknowledge it has become increasingly difficult to negotiate with payers to allow E/M billing outside of global (unless you are over the threshold number of visits).   The usual E&M services and guidelines would apply. With this option, the MFM billing should include the taxonomy code of MFM (207VM0101X), rather than OB (207V00000X).



    It seems to me your situation falls into "b" - you could bill the appropriate antepartum care only code for the portion you performed after 32 weeks (late transfer into your group), and then the delivery/PP codes.  Our preferred reporting method is "c" - which is you bill your E&Ms for your visits after 32 weeks and then the delivery/PP codes - but as noted, the is not always reimbursed these days.

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    Vanita Jain, MD
    Chair, SMFM Coding Committee
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  • 4.  RE: late transfer of care.

    Posted 08-13-2020 14:27

    I have a follow up question regarding maternal transports. In my previous practice if the mfm did the delivery only for a maternal transport we would bill a delivery only code (59409) with no post partum care.  The referring physician would bill for antepartum and post partum 59430 if they did all the outpatient post partum follow up visits. 

    if our practice did the delivery and outpatient postpartum follow up including the 6 week post partum we would bill 59410. 


    my current practice and coding department is billing 59410 for delivery with inpatient post partum care. Then billing additional 59430 if We do the Outpatient post partum visit. If the referring doc does the outpatient post partum follow up and billing 59430 my coders are still billing 59410 for our delivery / inpatient care. Could you please clarify for me what are the correct codes for these scenarios? 


    thank you,
    Amie Hollard 



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    Amie Hollard
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  • 5.  RE: late transfer of care.

    Posted 08-13-2020 18:26
    Hi Amie,
    When billing delivery only and inpatient-only postpartum care:
    Code 59409 for vaginal delivery only (or 59514, 59612, 59620 for C-section, VBAC, and attempted VBAC, respectively), and bill each postpartum day with the appropriate E/M code.
    Per CPT, when reporting delivery only services, report inpatient postdelivery management and discharge services using Evaluation and Management service codes. This is directly from the CPT manual. The only time delivery with postpartum care is to be reported is when the delivering physician group is also doing outpatient postpartum care. I hope this helps!

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    Trisha Malisch
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  • 6.  RE: late transfer of care.

    Posted 02-25-2020 07:12
    You would only bill for the Prenatal Care given in your office with the appropriate codes depending upon how many visits were performed with the corresponding weeks she began care with you.  9921x for 1-3 visits, 59425 for 4-6 visits or 59426 for 7 or more.

     For the C/Section and post partum visit with 7 or more visits, you could bill  the 59510.  If you have less than 7 visits then your could bill your c/section as 59514 or 59515 (if including ppvisit).

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    Dawn G Baca  CPC, COBGC
    Office Coordinator, Certified Specialty Coder
    Ascension St John OBGYN Professionals
    22151 Moross  Ste 313
    Detroit, MI 48236
    office 1 313 343 7827  fax 1 313 343 4932
    Ascension St John Hospital
     

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  • 7.  RE: late transfer of care.

    Posted 02-25-2020 13:27
    Thank you Dawn for your detailed answer!

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    Fadi Bsat, MD
    Past Chair, SMFM Coding Committee
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  • 8.  RE: late transfer of care.

    Posted 02-25-2020 14:35
    thank you so much for all your answers, they were very helpful