Wiki Help needed with code for Pt in OBS

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az2tn@yahoo.com

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I am working on a denial for a pt who is pregnant and was admitted to OBS for cramping by her DR that sees her for her pregnancy so she is in that global period with the provider. The provider does not indicate whether it's related to the pregnancy or not but it sure looks related. I have been advised to append a 24 mod to the encounter but I wanted to see what some of you OB/GYN coders who work in this area every day opinions were because this does not seem right to me. I am not an OB/GYN coder though. I am a CPC who works denials for multiple specialties and this one has me stumped. From what I've read you can only bill for problems related to pregnancy if the pt is admitted to INPT status?
 
Help Needed for OBS Coding

I bill and get paid for services when one of our patients is admitted to Observation status. The POS is 22, and I use the appropriate diagnosis for the reason for the OBS admission, whether it is pregnancy-related or something different. I don't append a -24 modifier to my E/M codes. I assume you're using the Observation admission/subsequent visit/discharge codes and not Office or Outpatient E/M codes; if you are not using the Observation codes that may be the problem. The carrier should pay for the service as it falls outside of the routine antepartum care that is described in the global maternity/delivery code.

Lisa Scott, CPC, COSC
 
you must use an ICD-9 CM chapter 11 code as your principle dx code unless the provider specifically documents that the condition is not complicating the mgt of the pregnancy.
You would not use the 24 modifier as stated above and you should use the ods codes and the 22 modifier.
 
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