Wiki ED Visit vs. OP E/M


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I am an OB/GYN Coder and my docs sometimes see patients in Labor & Delivery if they come into the ER. I code these visits w/ E/M codes 99201-99215 because it is all outpatient. They are sent to Labor and Delivery from the ER. One of my docs seem to think that L&D is an extension of the ER and wants to code 99281-99285 because the description of an ER dept per CPT is "an organized hospital based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day." I need some justification on my part about why we dont code ER visits if they are sent from the ER to Labor and Delivery. Any advice?:confused:
The different catergories of E/M codes (Office/Outpatient, Inpatient Hospital..etc) reflect the location of service. Therefore, if your provider is treating a patient in the ER, then you would use the Emergency Room E/M codes (99281-99285). If your provider is treating a patient in Labor and Delivery, then most likely the patient was admitted and thus you would use the Inpatient Hospital E/M codes.- 99221-99223 for the initial hospital visit and 99231-99233 for subsequent visits. :)
The patient isnt admitted when they are sent to Labor and Delivery. That location is outpatient. They are normally routed there from the ER because they are pregnant.
What are the documented circumstances for these ER patients to be "routed" up to L/D? Does the ER physician protocol send ALL OB patients to this inpatient area, or are there conditions present upon ER examination that would have one of your OB?GYN docs called in to evaluate these women? Just need a bit more information, if you would.
All pregnant patients are normally routed to L&D so our OB docs can evaluate them to make sure the mother and the fetus are ok. If the pregnant patient comes in with foot pain (something unrelated to the fetus) the the ER doc would evaluate them first for foot pain and then most likely send them to L&D