Ob-Gyn Coding Alert

Question: My ob-gyn admitted a patient on the 18th and saw her on the 19th. Then he did a fetal non-stress test (NST) on the 20th. However, the hospital coder claims the patient was in fact in the emergency department on the 18th, was in observation status on the 19th and was not officially admitted until the 20th. How should I code the admission visit? New Mexico Subscriber Answer: The doctor is the person who decides when to admit the patient to inpatient status. If the ob-gyn gave orders for the patient to be directly admitted to inpatient status, the hospital should not retroactively say that the patient was in observation status. You may need to address this with your hospital staff. The genesis for this concern may be the fact that many patients require preauthorization for inpatient services.

You should not bill an admission (99221-99223, Initial hospital care, per day ...) unless your ob-gyn saw the patient on that day. If your doctor gave orders for his patient to be admitted on the 18th but never saw her in that setting until the 19th, you should report the initial hospital care codes (99221-99223) on the 19th.