Ob-Gyn Coding Alert

Ob-gyns often use a fetal monitor to determine if a woman is in labor, but that doesn't mean you should report 59025.

Key: Most likely you-ll include this fetal monitor use as part of labor management or the global ob package (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care).

Example: A patient at 38 weeks gestation presents to the ob-gyn saying her water has broken but she doesn't feel any contractions. The ob-gyn checks her and sees that she's dilated 3 cm. Before admitting her to the hospital,the ob-gyn evaluates the situation by placing an external transducer to determine if the mother is experiencing contractions. Because the ob-gyn uses the fetal monitor to assess the mother and not fetal well-being, you should include this test as part of the labor check, which would be part of the global ob package (such as 59400).

Best bet: When a patient comes in and is hooked up to the monitor, and the ob-gyn determines the patient is in labor, you should generally not code this service. You should also not code for a labor check when the patient goes to the hospital for observation and is then admitted for delivery.

On the other hand, you may find a way to be indirectly reimbursed for the labor check. The ob-gyn may perform the labor check, but as long as the patient does not deliver within 24 hours of admittance, you can include the reimbursement for the labor check in your codes for initial hospital care (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...) for this premature labor situation. The important factor here is that the ob-gyn did not admit the patient for delivery. Therefore, you can report the initial care separately from the global ob period.

Red flag: If the patient does deliver within 24 hours of admission, you should consider the labor check part of the global.

Example: A patient at 30 weeks presents to your obgyn in labor. The ob-gyn admits her to the hospital and places the external transducer on the woman's abdomen,giving her medication to halt the labor. Based on the readings from the transducer, the labor stops. In this situation, you should include labor checks in the hospital admission fee (99221-99223). The ob-gyn did not use the external transducer to examine the fetus's condition but to monitor the patient's contractions. Therefore, you would not report a separate NST.