Coding for postpartum care after at-home delivery
<huc>Q</huc> How should our practice bill for a woman who presents to the hospital for an evaluation after delivering at home? She is an established patient of one of our physicians.
<huc>A</huc> The answer depends on whether the home delivery was planned or the patient simply did not make it to the hospital in time. If planned and her physician or a collaborating nurse midwife did the delivery, use 59400 (routine obstetric care, including antepartum care, vaginal delivery [with or without episiotomy and/or forceps], and postpartum care) and do not bill separately for the postpartum evaluation in the hospital. If the patient delivered at home unintentionally, only bill for the postpartum care using 59430 for uncomplicated inpatient or outpatient visits until 6 weeks’ postpartum, or report the global code with the modifier -52 (reduced services).
This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.