You Be the Coder:
Coding for Hospital Transfers
Published on Sat Sep 01, 2001
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our patient arrived at Hospital A to deliver her baby, but complications from H.E.L.L.P. syndrome (624.5, severe pre-eclampsia) forced us to transfer her to Hospital B. My physician was 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?
Illinois Subscriber
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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 proper code is in the 99234-99236 range (observation or inpatient hospital care ...). Your question suggests that since your physician did not do the delivery at Hospital B, he also did not do an admission to Hospital B. If he did do the admit (but not the delivery) to Hospital B, some payers may be willing to let you bill for that service on the same day by using the regular hospital admit code (99221-99223, initial hospital care, per day ...). They may also apply the CPT rule of "one E/M code per day." If so, you would only bill for the last E/M service performed, but you would include 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 are billing global ob care for this patient, you would submit the global code with modifier -52 for reduced services, and the delivering physician would bill for delivery only, vaginal or caesarean, whichever is appropriate. | |
