Ob-Gyn Coding Alert

Reader Question:

Observation During Postoperative Period

Question: We have a patient who had a dilation and curettage (D&C) for a missed abortion, but when she had her preoperative chest x-ray, it was found that she also had pneumonia. She entered the hospital one day to have the D&C done and was discharged the next day. She had 23 hours of observation for the pneumonia, otherwise she would have gone home the same day. Can I bill additionally for the pneumonia treatment from our physician?

Wisconsin Subscriber

Answer: You can bill for both the surgery and the postoperative observation for pneumonia if your physician treated the pneumonia. But if its two different dates of service it is considered two days of care not 23-hour observation. The question now becomes whether the patient was an inpatient during the 23 hours or was only in observation status during this time period, and that will determine the correct code to use. The CPT codes for treatment of missed abortion (59820 and 59821) both carry a 90-day global period, which means the observation or inpatient care would normally be included. To bill separately for managing the pneumonia, the physician would report either the inpatient care code or observation code that represented the level of service for this management, and you would add modifier -24 (unrelated E/M service by the same physician during a postoperative period) for that management. It is a good idea to send the progress note with a brief note explaining the patients condition and treatment. Be sure to link each service with its justifying diagnosis, that is, 632 for the missed abortion, and the appropriate code for pneumonia (there are scores of different types) linked to the E/M service.