Coding challenge


Fam Pract Manag. 1999 Apr;6(4):9.

To the Editor:

We are concerned about your response to the question on prolonged labor and a C-section (“Coding & Documentation,” September 1998). A physician in our group wishes to bill following your recommendation, but we don't believe the recommendation follows CPT guidelines.

According to CPT, delivery includes admission to the hospital and the admission history and physical. So, the physician should not also bill an initial hospital service (99223) as the answer suggested. Delivery is not a time-based code; the time involved in delivery, including labor, is inherent in the service. And the prolonged service code is not billed with a service that doesn't have a defined time. Therefore, the article's recommendation to bill the prolonged service code with the delivery code is also inappropriate.

We believe the correct codes would be 59425 (antepartum care), 59514 with modifier -80 (assisting at the C-section) and 59430 (postpartum care).

Author's response:

As you noted, according to CPT, “Delivery services include admission to the hospital, the admission history and physical examination, management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps), or cesarean delivery.” However, CPT goes on to state that “medical problems complicating labor and delivery management may require additional resources and should be identified by utilizing the codes in the Medicine and Evaluation and Management (E/M) Services section in addition to codes for maternity care.”

The labor in question involved abnormalities in the fetal heart rate that required the physician's continued presence at the hospital. We believe this situation qualifies as a medical problem complicating labor and delivery management that requires additional resources, and thus it should be identified using E/M codes.

While CPT leaves room for differing interpretations on this point, we continue to believe that our interpretation is a reasonable one. However, we can't guarantee that third-party payers will accept the recommended coding.


Copyright © 1999 by the American Academy of Family Physicians.
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