Ob-Gyn Coding Alert

Question: What hospital charges can the physicians report for obstetric patients?

California Subscriber

Answer: You can sometimes bill hospital services outside of the global package. For instance, you could report the admission history and physical (99221-99223, Initial hospital care, per day, for the E/M of a patient ...) and any subsequent care (99231-99233, Subsequent hospital care, per day, for the E/M of a patient ...) if the ob-gyn admits the patient for a complication of pregnancy. But payers will usually not reimburse you for a service that takes place within 24 hours of the delivery.

Gray area: The 24-hour period is open to debate because payers tend to go by calendar dates and not hours in a day or number of hours prior to delivery. Generally, if you admit a patient on day one because of premature labor contractions that you were trying to stop and you deliver on day three, the carrier should pay for day one and two outside the package. The payer would not reimburse separately for day three because that was the date of the delivery.

Also, you can bill separately for procedures (other than labor management) the physician performs while the patient is in the hospital. For instance, most carriers consider induction of labor part of labor management, and hospital staff, not the physician, usually starts the IV. However, you can use the IV infusion codes (90765-90767, Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug] ...) if the physician personally starts the IV, sits with the patient the entire time, and documents that time.

If the ob-gyn admits the patient to the hospital for a condition and then discharges her without delivery, you can bill for the admission, the subsequent care and the discharge day management (99238-99239, Hospital discharge day management ...).