ED Coding and Reimbursement Alert

Question: One of our physicians was called to the floor because a patient was giving birth and the baby was crowning. When the doctor arrived, the physician was only in time to clamp the cord. How should I report this?


Virginia Subscriber

Answer: If the documentation does not support use of the vaginal delivery code (which, in this case, it probably doesn-t), then you are left with two choices: a consult code (99251-99255) or a subsequent hospital care code (99231-99233). If you opt for a consult code, you-ll need to select the most appropriate of the following:

- 99251--Initial inpatient consultation for a new or established patient, which requires these three key components: a problem-focused history, a problem-focused examination, and straightforward medical decision-making

- 99252---an expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision-making

- 99253---a detailed history, a detailed examination, and medical decision-making of low complexity

- 99254---a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity

- 99255---a comprehensive history, a comprehensive examination, and medical decision-making of high complexity.

Hint: To report a consult code, you need a documented request in the chart from the attending physician, a consultative written report, and a return of care to the primary attending physician. Absent those criteria, you should report one of these subsequent hospital visit codes:

- 99231--Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history, a problem-focused examination, and medical decision-making that is straightforward or of low complexity

- 99232---an expanded problem-focused interval history, an expanded problem-focused examination, and medical decision-making of moderate complexity

- 99233---a detailed interval history, a detailed examination, and medical decision-making of high complexity.