Ob-Gyn Coding Alert

Question: We have a few patients that our Maternal Fetal Medicine doctor saw in the hospital for consults while they were under observation. Is there an observation consult code to bill? He is marking a 99254, but that’s for inpatient. What should I do?

Texas Subscriber

Answer: Care during observation, in labor and delivery, or that takes place in the emergency department are classified as outpatient, not inpatient services. Therefore, only the outpatient consultation codes would apply.  In this case, the code range would be 99241-99245 (Office consultation for a new or established patient, which requires these 3 key components…). This, of course, assumes that the payer still accepts the consultation codes.  If not, the appropriate outpatient service code (99201-99215) would be reported instead.