Ob-Gyn Coding Alert

Question: Our patient arrived at Hospital A to deliver her baby, but complications from H.E.L.L.P. syndrome (624.5x, Severe pre-eclampsia) forced us to transfer her to Hospital B. My physician arrived at Hospital A to deliver, did the admit with history and physical, but did not deliver her after she transferred. How should I code this?

Colorado Subscriber

Answer: If your physician did not do the delivery, and you are charging for the admit and discharge on the same day (from Hospital A), the code would be in the 99234-99236 range (Observation or inpatient hospital care ).

Your question suggests that because your physician did not do the delivery at Hospital B, he did not do an admission to Hospital B either. But if he did, some payers may be willing to let you also bill for that service using the regular hospital admit code (99221-99223, Initial hospital care, per day ). Some payers, however, may apply the CPT rule of "one E/M code per day," so you would bill only the last E/M service type, which includes all of the services provided to the patient on that day for purposes of selecting the level of E/M code (whether it is observation/hospital discharge on the same day, or the regular admit code at the second hospital).

If you were billing for global ob care for this patient, you would submit the global code with a -52 modifier for reduced services, and the delivering physician would bill for delivery only, vaginal or cesarean, whichever is appropriate.