Coding for Intrapartum Care and Other Obstetrical Services

Coding is the process of accounting for what we do .. so that we can get reimbursed for it.  Car mechanics have the flat rate manual that tells them what to charge us.  In medicine, there are similar, but more complicated methods of accounting for what we do.  One of the most complex is coding for obstetric services — especially when the family physician is not the one who ultimately does the delivery — as is the case of a c-section done by an obstetric colleague.  We had another such episode this week, and it reminded me that coordination of the billing is important.  Not only do we family physicians need to communicate closely with our obstetrician colleagues closely regarding the care of the patient, but we need to coordinate our billing as well.  AAFP publishes these guidelines … and there are many others ..

The key is that most insurers expect to pay for the delivery.  So I spend 14 hrs at the hospital and I deliver the baby .. the reimbursement is the same as if  I spend 5 minutes.  Nor like the car mechanics .. but it usually works out OK .. unless my patient needs a c-section.  In this case,  the obstetrician bills for the (operative) delivery and I bill for my time .. or at least I attempt to.  I can also bill for assisting with the c-section .. in which case I can't bill for the time associated with the (attempted) vaginal delivery.

Very complicated stuff .. and certainly nothing that I ever wanted to learn in medical school.