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Emergency visits during pregnancy.

  1. Question Emergency visits during pregnancy.
    Medical Coding Books
    . What is the most appropiate cpt for labor and delivery evaluation?

    These patients go to the emergency room and sometimes if they're over sixteen weeks the OB/GYN doctor instead of examining the pt in the ER the pt is taken to the to the labor and delivery floor for evaluation. Most of the times the get evaluated and go home if not the same day the next. The hospital always codes ER visit 99241-99245. What would the physician code?

  2. #2
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    If the patient is admitted observation and goes home the same date use 99234-99236. This set of codes is also applicable if admitte inpatient and discharged on the same date. Otherwise, if obs admit one day and d/c the next 99218-99220 for obs admit and 99217 for the next day d/c.
    Lisa Bledsoe, CPC, CPMA

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    Does it matter if the pt is global?
    Quote Originally Posted by Lisa Curtis View Post
    If the patient is admitted observation and goes home the same date use 99234-99236. This set of codes is also applicable if admitte inpatient and discharged on the same date. Otherwise, if obs admit one day and d/c the next 99218-99220 for obs admit and 99217 for the next day d/c.
    How about false labor at TERM between 36 and 40 and post term bet 40+?
    Last edited by howardi; 05-20-2009 at 12:09 PM. Reason: I forgot about ER visits at term, where there are no complicatations and pt are sent home after quick eval w/ NST?

  4. #4
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    Greeley, Colorado
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    No. If they are admitted (IP or obs) for a complication (i.e. pre term contractions, bleeding, pre eclampsia, etc) it is separately billable.
    Lisa Bledsoe, CPC, CPMA

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    Thanks

  6. Default
    How about false labor at TERM between 36 and 40 and post term bet 40+?

  7. #7
    Location
    Greeley, Colorado
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    If the patient is only checked and not admitted obs or IP, then use 99212-99215 as appropriate.
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Default What aboutif patient was admitted for 3-4hours
    What about if patient was admitted for 3-4hours and then discharged? due to false labor.

    Observation codes for same date admission and Discharge, patient has to be at least 8hrs admitted in the hospital and no more than 24hrs to qualify for this code.

    how should we code this service. is this included in global code as part of Ob care?

  9. #9
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    Quote Originally Posted by lupita70 View Post
    What about if patient was admitted for 3-4hours and then discharged? due to false labor.

    Observation codes for same date admission and Discharge, patient has to be at least 8hrs admitted in the hospital and no more than 24hrs to qualify for this code.

    how should we code this service. is this included in global code as part of Ob care?
    Usually labor checks are considered to be part of the global OB package. This is where you need to check with your carrier. Some carriers will let you bill out "complication" visits right away with a 25 modifier & an appropriate OB complication dx code. Some carriers will want you to wait until patient delivers and then bill out extra visits only if the paitient had more than 13 or 14. Some carriers will pay for extra visits done outside the normal prenatal visit schedule. Some carriers will want you to bill out the global OB code with a 22 modifier.

    I keep a document folder with copies of all my major carriers' Global OB guidelines. That way I can tailor the billing based on an individual's carrier.

    Becky, CPC

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