Ob-Gyn Coding Alert

Question: A patient at 39 weeks gestation was admitted to labor and delivery with severe variables. The ob-gyn documented that she performed a contraction stress test, biophysical sonogram and prolonged monitoring for three hours. The patient was admitted and discharged on the same day. How should I code for the prolonged monitoring?

Oregon Subscriber Answer: If the physician admitted and discharged the patient on the same day, you should report an observation/inpatient same-day admission and discharge code (99234-99236), depending on the level of service provided. These codes, however, do not have a time component. Therefore, you cannot report the prolonged monitoring services with +99356 (Prolonged physician service in the inpatient setting, requiring direct [face-to-face] patient contact beyond the usual service [e.g., maternal fetal monitoring for high-risk delivery or other physiological monitoring, prolonged care of an acutely ill patient]; first hour [list separately in addition to code for inpatient evaluation and management service]) or +99357 ( each additional 30 minutes [list separately in addition to code for prolonged physician service]). This is the case no matter how long the doctor was with the patient.

On the other hand, if the ob-gyn never formally admitted the patient to observation or hospital inpatient status, you can bill for outpatient care. In the above case, you would report the appropriate established outpatient code (99212-99215), depending on the level of service provided. You would bill +99354 (Prolonged physician service in the office or other outpatient setting ...; first hour ...) and +99355 (... each additional 30 minutes ...) to report the additional time the physician spent with the patient.

In addition to the E/M codes, you should submit the contraction stress test (59020*, Fetal contraction stress test) and the biophysical profile (76818, Fetal biophysical profile; with non-stress testing; or 76819, without non-stress testing).   The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.; and Harry L. Stuber, MD, an independent gynecologist based in Cookeville, Tenn.