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Ob-Gyn Coding Alert

Reader Questions:

How to Report an ED Visit During Pregnancy

Question: A pregnant patient presents in the emergency department (ED) during her pregnancy complaining of abdominal pain, cramping, etc., and is transferred to labor and delivery for observation (where she is admitted and released on the same day). Can the physician bill for this, or is this visit considered part of the global service?

Michigan Subscriber Answer: Assuming the physician physically saw the patient in observation that day, you can bill for it using 99234-99236 (Observation or inpatient hospital care ... including admission and discharge on the same date ...).
But keep in mind that the minimum documentation requirement for observation care is a detailed history and exam. If this is not in your ob-gyn's record (and it must be performed by the admitting physician), you cannot bill an observation code but would revert to an outpatient visit.
Also remember that if your physician saw her in the ED and then transferred her to observation status, you should bill only the observation care (in your scenario, the same-day admit and discharge code from the 99234-99236 series).
If the labor and delivery nursing staff handled this with only a phone call from the physician, you should consider it an unbillable service. -- The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.