Coding Certification- Certified Coder
So this is an OB question and when I teach this, I say in class, ìHow many ways are
there to deliver a baby?î and most people will say, ìWell, two: vaginally and cesarian.î
And coding-wise, thereís actually 4 ways.
Thereís vaginal, cesarean and Boydís going, ìWhat?î And thereís VBAC which is Vaginal
Birth After Cesarean.
But thereís successful VBAC and failed VBAC.
So those are the 4 main groups when you want to think of OB delivery time.
How is the baby delivered?
Those are the 4 different ways.
So in this question, it says that even thoughÖ or although the patient had a previous cesarean,
the physician allowed her to attempt a vaginal birth ñ thatís a VBAC ñ and after trying,
it didnít work.
Okay so they ended up doing a cesarean anyways.
Thatís a failed VBAC.
So if you look in your coding manuals, youíll see those 4 groupings.
So what I did on the next slide is I took this question and I wanted to show her how
to break it down.
Hopefully youíre on duty.
And I did my little color coding like I was explaining before, try and find the patterns.
So right away, hopefully youíll learn from the previous slide, my mindís thinking A
is going to be wrong even if I didnít read it because Iíve got 3 instances of the 618
code, the 59618.
So to me, thatís got to be a correct code and thatís an answer B, C, and D. So Iíve
already thrown out A with hardly even looking.
And becauseÖ letís see here.
Alright so I did look it up and thatís routine obstetric care including antepartum, the cesarean
delivery, and post partum care.
So it talked about the physician seeing the patient, right?
Itís the same physician throughout, during the hospital stay and after, the same physician
provided the post partum care.
So they did the pre-opÖ not pre-op and prenatal, the delivery, and the post op.
Thatís called the OB package.
And the 4 packages are vaginal, cesarean, successful VBAC and unsuccessful.
So the 59618 is the unsuccessful, okay?
Because here, it ended up being a cesarean delivery following attempted vaginal delivery.
Okay, thatís your failed VBAC.
So we wouldnít code 59620 ñ cesarean delivery only ñ because itís bundled in to 618.
So answer B is wrong.
I know she was saying that that was what the answer key said but I donít agree with it.
So it could be a typo you know, things like that happen.
So that leaves it C or D.
Now the otherÖ this was twins, right?
Yes, with twin gestations.
Okay soÖ and it said, ì2 healthy newborns were born.î So if there was only one baby,
it would be 59618, done.
But because thereís two, the question is, ìHmm, do I report another unit of 618 with
a 51 or do I do modifier 22?î I did some research on it and Iíd say 80% of the answers
were modifier 22.
But some payers actually want you to list it twice with a 51.
So I donít think this is actually a good practice exam question because itís really
pulling in reimbursement stuff like payer preference stuff.
But if it were me, I would go with D unless I got information from the payer to do it
differently, okay?
OkayÖ oh, and I have one little extra thing because it used to always confuse me.
Gravida 2 Para 1 unless youíre you know, an OB person where youíre familiar with this.
I think I have the next slide for that.
Again, I got this from Find The Code.
They have the Dorlands Medical Dictionary built in there.
You could also you know, Google these.
But Gravida is a pregnant woman so Gravida 1 means during the first pregnancy.
So in our situation, she wasÖ Gravida 2 Para 1 because this is her second pregnancy.
And the Para 1 means she hadÖ has a previous child thatÖ so a woman who has produced viable
young regardless of whether the child was living at birth.
So Gravida 2 Para 1, itís her second pregnancy and she delivered once before.
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