Wiki One day Visits to Labor & Delivery

[BeckyC]

Hello All,

One of the revenue teams I manage supports our GYN/OB department and I have been challenged on the way we are billing our OB patients who are seen and sent home same day from L&D. All OB patients are directed to L&D so the patient could be seen for a non-OB problem, pregnancy complication or labor check which I understand most payers don't cover the latter separately. What is being challenged is the use of outpatient codes (99201-99205, 99212-99215) when the patient's status with our hospital is outpatient. Our interim chair insists this is in error because those are office codes and we should be using the hospital E&M codes which I explained we cannot use because the patient is not designated as inpatient or observation. Should we be using a different set of codes and if so what are they? Thanks in advance for any guidance you can offer.

 

[tracylc10]

I know in our practice, observation is considered outpatient. We use 99234-99236 for the same day admit/discharge visits for L&D.

 

[kathyvl74]

you are correct, the patient has to be designated as observation or inpatient to bill the obs/inpatient visit codes

 

[BeckyC]

Hello Again,

So far I have a split decision, one practice uses observation codes and another agrees with what I noted. Does anyone have a reference they can provide for this billing scenario? I have checked ACOG's FAQ book but they don't address this.