Ob-Gyn Coding Alert

Question: A patient pregnant with twins came to our office for a threatened abortion. The ob-gyn performed an ultrasound. The patient's water broke, and the ob-gyn delivered the first twin at 16 weeks in the office. He got the patient to the hospital where she delivered the second twin and then performed a D&E. What should I code for this?

New Mexico subscriber

Answer: You can only code the spontaneous delivery of a fetus under 20 weeks 0 days (unless it was alive at birth) as an E/M service. However, in this case, you can tack on prolonged physician services as well as the code for the ultrasound (768xx).

Since the ob-gyn saw the patient in the office and then the hospital admitted the patient on the same day, all of the office work combines with all of the hospital work to assign the hospital admit code (which will be a high-level code). You can add on the inpatient face-to-face prolonged care, as long as your documentation meets the rules for using these codes.

If your ob-gyn performs a D&E on the same date as the admission, you should append modifier -57 (Decision for surgery) to the admission code and report the D&E separately - 59812 (Treatment of incomplete abortion, any trimester, completed surgically), assuming that retained placental fragments existed.

Note: This code has a global period, which means that it includes all subsequent care in the hospital and discharge care (and probably post-op in the office as well).