Ob-Gyn Coding Alert

Although observation care coding can be complicated and frustrating, you shouldn't overlook it. Clear documentation is the key to ensure that carriers reward your ob-gyn for his or her observation services. Before reporting observation codes (99218-99220 and 99234-99236), you must ensure the documentation clearly indicates that the physician admitted the patient to observation status and personally saw the patient at the time of the admission. The ob-gyn's admitting order must state, "Admit to observation status." But the hospital doesn't have to have a designated "observation unit" for you to use these codes, says Lynn M. Anderanin, CPC, senior coding consultant for Healthcare Information Services LLC in Des Plaines, Ill. In addition, all observation codes are per-diem codes. And just like other E/M codes, you can bill only one observation code per day. But unlike the inpatient and outpatient codes that you may be more familiar with, observation codes do not include a time element for counseling and coordination of care. This applies to the same-day admission and discharge codes as well. By reviewing the following six coding scenarios, you should be able to clear up your observation care reporting and get your ob-gyn the reimbursement that he or she deserves. 1. Patients admitted to inpatient status from observation status the same day. In this case, you may report the inpatient admission code (99221-99223). The coding rules treat the observation status stay as they would any outpatient or emergency department stay. You would combine the observation care documentation with the inpatient admit documentation to determine one level of inpatient care for that day. For example, says Brenda Dombkowski, CPC, a coding specialist at Obstetric-Gynecology & Infertility Group in Cheshire, Conn., at 8 a.m., the ob-gyn admits a pregnant patient who has been in an automobile accident to observation status, even though she does not seem to have any problems. At 4 p.m., the patient starts to bleed vaginally, and the physician immediately admits her to an inpatient unit. The ob-gyn will report 99221-99223 for his or her services that day. You will include the observation work associated with the admission when determining the inpatient admit code. 2. Patient admitted to observation status from an outpatient setting. Here, you should combine all outpatient (such as an office, emergency department, or outpatient surgery center) documentation with that for the observation care to determine one level of observation care for that day. For instance, a patient presents with premature labor, Dombkowski says. After examining the patient and observing her in the office for a while, the physician admits her to the hospital observation unit when the labor pains do not abate. The doctor will code 99218-99220 for his or her services that day. You [...]