Ob-Gyn Coding Alert

Question: How do you code for an ob patient seen in observation for pre-term labor? Im confused as to which code to use: 99218-99220 or 99234-99236.

Family Health Associates
Lewistown, PA 17044

Answer: The CPT codes 99218-99220 are reported when the patient is admitted to observation status and remains in that state for the day of admission. For example, the patient is admitted at 10 am and is still in observation status at midnight of the same day. Technically, since most payers process claims by service date, these codes could be reported even if a patient was admitted at 11 pm, but not discharged until the next calendar date. Many payers may require that the patient be in observation status for some specified number of hours on a single service date in order to qualify for observation (eg, Medicare defines observation status as that lasting 12 or more hours). When their definition is not met, the outpatient codes would be reported instead.
The CPT codes 99234-99236, on the other hand, are used when the patient is admitted and discharged from observation status on the same calendar date. Again, some payers may have a time criterion before observation can be reported.