Ob-Gyn Coding Alert

In these times of managed care and reduced reimbursement every dollar counts. You need to be able to legitimately code for everything done for a patient and not miss any opportunities. According to coding expert and practice administrator Thomas Kent, CMM, Obstetricians often miss billing for supervision of IV medications.

While starting and looking after an IV medication drip in the hospital setting is usually considered to be nursing territory, there are circumstances in which the obstetrician closely supervises the procedure. For example, a full term ob patient is admitted to the hospital with ruptured membranes but does not commence labor. The obstetrician decides to induce labor and orders an IV with Pitocin (the trade name for oxytocin), and feels compelled to monitor the administration of the medication and the progression of labor personally. According to Kent, the CPT allows coding for this service using codes 90780 and 90781.
The codes come from a CPT category called Therapeutic or Diagnostic Infusions (excluding chemotherapy) and cover prolonged intravenous injections. Specifically, these codes are for intravenous injections that require the presence of a physician. They are not for intradermal, subcutaneous or intramuscular or routine IV drug injections (those codes are 90782-90788).

The induction of labor is usually considered part of a global ob service, but these codes are for those special circumstances when dedicated time needs to be invested in monitoring the administration of the medication. The important requirement of coding for this service, Kent says, is that the physician must supervise the initiation of the drip, be present on the floor and personally monitoring the patient to such a degree that he is precluded from doing anything else. The 90780 is for the initiation and first hour of the infusion, and 90781 for each additional hour up to eight hours.