Ob-Gyn Coding Alert

When an ob/gyn is called to see a patient in the emergency room (ER), a number of different scenarios and outcomes can take place. Although automatically coding the visit as an ER consult may seem pretty basic, there are several different elements to consider before identifying the visit as a consultation.

An emergency room consultation can be very confusing for people, says Thomas Kent, CMM, principal of Kent Medical Management in Dunkirk, Md. When a doctor sees a patient in the ER, many coders first reaction is to use the code for an emergency room visit (99281-99285, emergency department visit for the evaluation and management of a patient). But the rule to remember is that only the first doctor who sees the patient can use the ER code. So if the ob/gyn is called to the ER by another doctor who has already seen the patient, the ob/gyn cannot use the ER code to bill the encounter. If you remember this ground rule, says Kent, things are a little more clear when determining the proper code.

The flip side of this rule is when a patient calls into the ob/gyns office with a complaint. If the ob/gyn advises the patient to meet him or her at the emergency room, the patients first encounter would be with their ob/gyn and the appropriate level of ER code would apply. But, Melanie Witt, RN, CPC, MA, former program manager of the department of coding and nomenclature at the American College of Obstetricians and Gynecologists (ACOG), advises, The physician can choose to code either an ER visit or an outpatient visit in this case and should be aware that reporting a emergency room visit does not always result in a higher payment. This is because ER codes do not have a time component and all three of the key components of history, examination and medical decision-making must be met or exceeded.

Making Sure the Service Adds Up
to the Proper Code

This may mean that the physician will end up coding a lower level of ER visit. For instance, says Witt, lets say that the physician sees the patient in the ER for vaginal bleeding. The patient is his established patient and he has been treating her for this condition for two weeks. She is having particularly heavy bleeding so he tells her to meet him in the ER. He performs a detailed examination, documents an HPI (history of present illness but not a family, personal or social history), documents a pertinent review of systems and then decides to perform surgery (so that medical decision-making is moderate). With this scenario, the level of history will be only problem-focused, meaning that instead [...]