Ob-Gyn Coding Alert

Question: A patient reported to the office with a positive pregnancy test and pain and bleeding. She was sent to the hospital for surgery, and the physician admitted her for 24 hours observation prior to surgery. Can I bill for the E/M visit in the office with modifier -57? Or do I just bill for the admit and surgery?

Florida Subscriber

 
Answer: If the services all took place on the same day, CPT advises you should bill the highest level of service for the day. An observation care code from the 99218-99220 series would be appropriate in this case.
 
Note that the office care counts toward the level of observation care. If the surgery was performed the day of the office care or the day after, you can append modifier -57 (Decision for surgery) to the observation care as the date representing the decision to perform surgery. The surgery is then coded on its own. You have not specified the surgery that was performed; this will also make a difference in modifier use.
 
If the procedure had a zero- or 10-day global period, add modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service provided on the same day. No modifier would be used if the surgery was performed the next day.
 
If the procedure had a 90-day global period, use modifier -57 on the E/M service that occurred the day of or the day before the surgery.