Ob-Gyn Coding Alert

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If you need to report an emergency department (ED) visit as well as a critical care code (99291), you should keep in mind that a bundle, care of the National Correct Coding Initiative (NCCI), version 12.3, prevents you from reporting both.

ED Visit, Critical Care on the Same Day?

You should be wary of reporting ED visit codes 99281-99285 alongside critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). The ED visit is now a component to the comprehensive critical care service, and you can't separate this with a modifier -- no matter what, thanks to a modifier indicator of -0.-

-Cases where you would report both an ED visit (99281-99285) with 99291 are rare, and I can see why payers would deny this,- says Dianne Wilkinson, RHIT, CCP, compliance officer and practice consultant for MedSouth Healthcare PC in Dyersburg, Tenn.

Example: A pregnant patient presents to an ED after a fall, where she is seen by the ob-gyn on call. The ob-gyn determines that the patient has no apparent effects of the fall because the fetal heart rate is strong, and he finds no evidence of bleeding.

The ob-gyn discharges her home, but four hours later she presents to the ED with hemorrhaging and falling blood pressure. The same on-call ob-gyn admits her to critical care for 35 minutes in total. In this case, you should report 99291 only.

Know the Limits

Keep in mind: You should only report 99291 once per day, says Bett Hales, CPC, assistant manager at Naugatuck Valley Ob-Gyn Associates PC in Waterbury, Conn. And remember that -your ob-gyn must document full attention to the patient, even if the time is not continuous, in the patient's record.-