Wiki Coding question-hospital coded fraudulently

[Cdawso2]

I have a question and it is actually about myself. I have been told by the Texas Dept of insurance that I do in fact owe this bill but I believe the hospital coded fraudulently. Please correct me if I am wrong. During my pregnancy my maternity benefits were covered at 100%. I had to go into L&D on two different dates of service for a NST and observation. The hospital coded both visits as ER visits and billed me for the 250$ copay. I don't understand why they codded at that place of service and level of care if it was not rendered. Am I wrong or should it have been coded as outpatient observation with NST?

 

[mitchellde]

It depends on how the physician wrote the order. He has to write the order to admit to observation for the stay to be classified as observation otherwise they will put it thru as an ER encounter. Either ask you doctor how he did it or obtain a copy of you records for those encounters and see if he did write the order.

 

[cheermom68]

Many hospitals now have OB ER's. They are not located in the regular ER, but are where you would have went previously for what was called triage or observation.