Wiki L/D Triage coding question

[k.shepherd59@yahoo.com]

I have a question about how a labor and delivery triage should be coded. The provider has coded it as a level 4 emergency department stay for false labor. Stay was under 8 hrs, was not seen by a doctor (but one was consulted over the phone), NST was performed and patient discharged. Dx code submitted was 661.93. Primary insurance carrier accepted claim and paid. Secondary insurance carrier denied and says Dx not appropriate for ER stay. Should the provider initially have billed it using 99212-15 instead of using ER coding?

 

[joylestenkof]

I would just use the code for false labor 644.13/o47.x.

661.93 would only be used on a inpatient claim for a delivery record for an arrested labor type scenario.

 

[k.shepherd59@yahoo.com]

Hi Joy,

Thanks for the reply. Do you think the entire stay should have been billed under something other than ER?

Thanks.

 

[CodingKing]

Unless she was admitted to observation status or inpatient status, ER is really all there is to bill. What do you mean by not see a doctor? There are no doctors working in the ER?

 

[Bready]

L/D Triage Coding Question

Unless the patient was actually seen and examined by the physician in the designated emergency department of the hospital, you cannot bill an ER visit. You would bill outpatient codes and if the physician did not have a documented "face to face" encounter with the patient you would not bill at all.