Coding

 I have a question regarding Inpatient and Deliveries. Can the same Doctor bill for admit and delivery same day?

Not unless there was extenuating circumstances, ICU admit, long discussion regarding need for delivery, might have to fight insurance, that it was not considered part of the usual and customary delivery.

This is more complex than stated........isnt everything in billing

1) MFM physicians should be billing fee for service (FFS) and not global. 

2) In the billing of FFS patients, if the patient is admitted in a non-planned manner (not for induction- PTL, PIH, etc), the admission should be billed

3) If the patient is admitted in a planned manner, it is part of the delivery billing. 

I will let others who are smarter opine.

Hi Barbara et al,

This is a great question MFM specialists typically do not bill the global OB care package used by OBGYNs, and therefore our billing can be very nuanced (and confusing). MFM specialist typically bill on a per visit fee for service basis.

Re the original question:
1. The delivery codes (global, delivery only, delivery + PP care), are inclusive of the admission to the hospital, admission history and physical, management of labor, fetal monitoring, and delivery, whether vaginal (with or without episiotomy and/or forceps), cesarean, or VBAC. You would therefore NOT bill the admission H+P separately – they are part of the delivery codes.  

2. Example scenarios where you would bill the H+P:

A. MFM and OB from different practice (DIFFERENT tax ID#):  If the MFM and OB are from separate groups, and the MFM provides the admission services for the patient, the hospital admission code (99223) can be billed by the MFM.  If the OB performed the delivery only then they would bill the delivery only code (59409).  No modifiers should be necessary. 

B. The patient is admitted to antepartum for a pregnancy complication – not labor. Admission H+P is billed by MFM. On a different calendar day down the road, OB or MFM performs the delivery only, then they would bill delivery only code.

C. MFM and OB same group (same tax ID #):  If both the MFM and the OB are from the same group (CPT considers same group to mean the same physician), and the MFM provides the admission due to a pregnancy complication, the admission code may be billed by the MFM if the admission was due to a pregnancy complication.  The modifier -25 (significant and separately identifiable E/M service by the same physician on the same day of the procedure or other services) should be appended.  The documentation must describe the complication and why an admission code was supported to add the modifier 25. You may expect to get a denial or record request or need to appeal in this scenario – especially nowadays.

I tried to keep it as simple as possible. Hopefully this helps clarify the original question. We are working on a White Paper for MFM Delivery Services since the topic is complicated. I am sure you can come up with other nuanced scenarios, and I would be happy to help! Alternatively, we encourage you to also post your questions to www.smfm.org/coding where the entire Committee reviews the question and responds.

Thank you!

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Steve Rad, MD, FACOG
Chair, SMFM Coding Committee
Los Angeles, CA
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