Ob-Gyn Coding Alert

Warning: You may not be able to count all of your ob-gyn's time as prolonged

If your ob-gyn is asked to perform a consultation in the hospital that lasts fifteen hours, you may have a case for reporting prolonged services - but you'll have to be careful about adding up the face-to-face time with the patient and making a case that this situation wasn't a transfer of care.

Scenario: Another provider called in our ob-gyn for a consult in the hospital. The ob-gyn was asked to evaluate the patient's fetal heart tracing and made a recommendation. At the time of the consult, she noted, "spontaneous rupture of membranes with labor augmentation," which was then discontinued.

She reviewed with the patient and spouse all of the variables of labor and the possible need of c-section due to the increased fetal heart rate variability. Our ob-gyn remained in the hospital about 15 hours over the course of the patient's labor, closely observing the monitor strip periodically and monitoring fetal well-being. She was in the room to ensure the patient and the fetus did well during the delivery.

Prior to the delivery, the patient's regular provider was not in the hospital and requested that the nurse ask our ob-gyn for her opinion of the fetal heart tones tracings on the monitor. Our ob-gyn has all this documented in her dictation.
 
Question: I know I can charge out the consult, but can I report prolonged care?

To start, CPT has a code that describes a consultant performing fetal monitoring during labor, including the written report and supervision and interpretation - 59050 (Fetal monitoring during labor by consulting physician [i.e., non-attending physician] with written report; supervision and interpretation). You would report 59050 at least two times.

As for whether you can bill the E/M service, you'll have to figure out whether this is a true consultation or your ob-gyn took over partial care of the patient. How your payer will view concurrent care will determine whether you can report anything other than 59050. For the initial visit, you may try to report an initial inpatient consultation (99251-99255). After that, your coding gets tricky. Decide Between These 2 Options Option 1: The ob-gyn provided a consultative service, performed the services described by 59050 several times, and was called back to do another follow-up consultation (99261-99263). Keep in mind that if this follow-up consultation happened on the same day as the initial consultation, you should not separately report it. Instead add up all consultative care for the day and pick the initial consultation code based on that information.

Option 2: The ob-gyn provided consultative services and checked the monitoring frequently as a standard of good care. If you can make a [...]