EM Coding Alert

You Be the Coder:

Admission Status Helps You Determine E/M

Published on Wed Nov 05, 2014

Question: A patient at 38 weeks gestation presented to her ob-gyn office saying her water broke but she doesn’t feel any contractions. Our ob-gyn checked her and saw she was dilated 3 cm. The ob-gyn evaluated the situation by placing an external transducer while in the office to determine if the mother was experiencing contractions and the results prompted the ob-gyn to admit her to the hospital. Should I code 59025 and 99211?

Minnesota Subscriber

Answer: You should not code 59025 (Fetal non-stress test), a 30-40 minute test that measures fetal well-being via fetal movement with contractions. The external transducer is part of an examination of the pregnant patient and is part of the E/M evaluation (99211-99115, Office or other outpatient visit for the evaluation and management of an established patient,…), thus it is not billable as a separate fetal non-stress test (NST), says Melanie Witt, RN, CPC, MA, an independent ob-gyn coding expert based out of Guadalupita, N.M.

You cannot report the admission separately because the patient is in labor, and the admission is part of the global package. The payer may deny the visit as included in global no matter where the service took place because the patient is at 38 weeks and the pregnancy is term, not preterm, Witt cautions.

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Admission Status Helps You Determine E/M
Question: A patient at 38 weeks gestation presented to her ob-gyn office saying her water broke [...]

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