Ob-Gyn Coding Alert

The CPT has a specific section for Emergency Department (ED) Services (codes 99281-99285). Their purpose are to report evaluation and management services provided in the ED. It defines an emergency department as an organized hospital-based facility for episodic services requiring immediate attention and available 24 hours a day.

Wasnt that the place you were called to by an ER doctor to evaluate a gyn patient? So why was your claim rejected when you used the Emergency Department Service codes?

The reason, says Doris Fullerton, CPC, president of the Fullerton Group a medical practice management consulting firm, is because many specialty doctors are using these codes incorrectly. Just because you see a patient in the emergency room does not justify the use of the Emergency Department Services codes. Heres some advice to help you choose the right codes for seeing patients in the ED.

1. Did the emergency room physician see the patient? Fullerton says this is the critical question. The only time you can use codes 99281-99285 is when you are the only physician seeing that patient in the ED. For example, a gyn patient calls you on a weekend and says she is having an acute problem (typically all ob problems immediately go to an ob department or to labor and delivery). You arrange to see her in the ED, and you notify the department staff so that they do not shift your patient to an emergency room physician. You see the patient, the problem is managed, and the patient leaves the ED without being turned over to the emergency doctor. You may now use the 99281-99285 codes. Had the emergency doctor seen this patient first, he or she would have used these codes, and your claim would have bounced back.

Rarely is the scenario this clean, however. A much more common situation is when the ob/gyn is called to the ED by the emergency physician as a consult or to take over the management of a specific patient. For example, a patient presents in the ED with a severe PID. The emergency physician evaluates the patient, but feels he would like the opinion of a gynecologist. There are a couple of options for coding these services based on what takes place.

If the gynecologist sees the patient in the ED and then discharges her or turns her back over to the emergency physician or the womans primary physician, then the ob/gyn would use the Office or Other Outpatient Consultations codes (99241-99245). If the gynecologist called in for the consultation also happens to be the patients regular physician, and he or she sees her only for her annual exam, and has not been following the specific problem that has brought her to the ED, you may also use this consultation code. But if the gyn has been actively following the patient for this specific problem its not considered a consultation. In other words, a patient cannot go to the ED and request that her physician be called in and still have the visit considered a consultation.

2. If the gyn sees the patient and then decides to admit her. In this instance, you can code with the admission codes (most common) 99221-99223 or with the inpatient consultation codes 99251-99255.

Using ED Visit Codes When using the Emergency Department Services codes no distinctions are made between new or established patients. An ED is defined as a hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. It must provide 24-hour services. Use of each of the following codes requires three E/M components. 99281 - a problem-focused history; a problem-focused examination; and straightforward medical decision-making. 99282 - an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity. 99283 - an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity. 99284 - a detailed history; a detailed examination; and medical decision-making of moderate complexity. 99285 - within the constraints of the patient's condition a comprehensive history; a comprehensive examination; and medical decision-making of high complexity.