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Wiki OB TRIAGE BILLING

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newfiegirl

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I am not familiar with this type of hospital in patient billing. My provider let me know that an OB patient was seen in triage. A face-to-face encounter was generated. What CPT codes would be used for this service? Thanks
 
Were they seen in triage and then discharged, or were they admitted? There are various factors determining if it can be billed.
 
nielynco said:
Then you would bill an outpatient E/M.
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Hi!
I saw this thread and I have a questions similar to the above question.
1.If an OB patient goes to triage to rule out labor and is only evaluated by an RN, not a physician or a resident, this cannot be billed as an outpatient E&M correct? The RN only gives a verbal to the attending via telephone.
2. If an OB patient goes to triage for blood pressure evaluation and is physically seen by the resident, can the attending still bill an outpatient E&M for the triage visit due to receiving updates from the resident plus attesting the resident's H & P?
For both questions, the pt is not admitted to the hospital. I am almost certain for question # 1, I do not bill, but the provider says otherwise.
Thanks in advance for your assistance.
 
Mely1697 said:
Hi!
I saw this thread and I have a questions similar to the above question.
1.If an OB patient goes to triage to rule out labor and is only evaluated by an RN, not a physician or a resident, this cannot be billed as an outpatient E&M correct? The RN only gives a verbal to the attending via telephone.
2. If an OB patient goes to triage for blood pressure evaluation and is physically seen by the resident, can the attending still bill an outpatient E&M for the triage visit due to receiving updates from the resident plus attesting the resident's H & P?
For both questions, the pt is not admitted to the hospital. I am almost certain for question # 1, I do not bill, but the provider says otherwise.
Thanks in advance for your assistance.
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Absolutely correct you cannot bill an E/M for example 1. A provider must see the patient to bill. This would not even qualify as an "incident to" service in this setting. For # 2 see the teaching physician rules for primary care services. https://www.hhs.gov/guidance/sites/.../Teaching_Physicians_Fact_Sheet_ICN006437.pdf
The above link should give you all the info you need.
 
Follow up question: What designates OB TRIAGE Billing? I am new to this terminology.... When a patient presents to the hospital ER they are triaged in the Emergency Room and either treated in the ED department (outpatient status - department ED) or sent to L and D (outpatient or inpatient department and patient type - service type status is driven by provider inpatient, outpatient (injections, blood transfusions, iv infusions, etc) or observation).
Next question - Is there a specific certification for your hospital to be able to TRIAGE OB patients (designated room, designated area).
Joint Commission requirements, state requirements, or is this driven by policy and procedures set in place by your hospital?
Emergency rooms do not bill for TRIAGE- they triage you and then place you in a specific status - outpatient clinic, ED department, inpatient, observation, etc.
I need help understanding this terminology... with links to support your response. Thank you in advance for your information; it is truly and greatly appreciated.
 
ccrowder said:
Follow up question: What designates OB TRIAGE Billing? I am new to this terminology.... When a patient presents to the hospital ER they are triaged in the Emergency Room and either treated in the ED department (outpatient status - department ED) or sent to L and D (outpatient or inpatient department and patient type - service type status is driven by provider inpatient, outpatient (injections, blood transfusions, iv infusions, etc) or observation).
Next question - Is there a specific certification for your hospital to be able to TRIAGE OB patients (designated room, designated area).
Joint Commission requirements, state requirements, or is this driven by policy and procedures set in place by your hospital?
Emergency rooms do not bill for TRIAGE- they triage you and then place you in a specific status - outpatient clinic, ED department, inpatient, observation, etc.
I need help understanding this terminology... with links to support your response. Thank you in advance for your information; it is truly and greatly appreciated.
Click to expand...
You will find an excellent article by ACOG regarding ob triage at the following link: https://www.acog.org/clinical/clini...7/hospital-based-triage-of-obstetric-patients.
 
I read the above referenced article and I may have missed it completely but I do not see where it states to bill out-patient E and M codes. Our patients are sent to L and D department for "OB triage" from the ED department. The "OB triage" or "Assessment" is done face to face by a provider and an order is written for the patient to be placed in outpatient observation (acute med/surg w/o telemetry observation) status and/or out-patient (outpatient) status according to the acuity of the patient and/or presenting problem. We bill based upon the order, patient type and service type department per insurance carrier guidelines. Our hospital will get an authorization (If required for observation status). I only code E and M if required by insurance carrier and/or the patient's hospital status is 100% outpatient status and not outpatient-observation status. I want to be billing correctly; help me ..... Thanks in advance.
 
ccrowder said:
I read the above referenced article and I may have missed it completely but I do not see where it states to bill out-patient E and M codes. Our patients are sent to L and D department for "OB triage" from the ED department. The "OB triage" or "Assessment" is done face to face by a provider and an order is written for the patient to be placed in outpatient observation (acute med/surg w/o telemetry observation) status and/or out-patient (outpatient) status according to the acuity of the patient and/or presenting problem. We bill based upon the order, patient type and service type department per insurance carrier guidelines. Our hospital will get an authorization (If required for observation status). I only code E and M if required by insurance carrier and/or the patient's hospital status is 100% outpatient status and not outpatient-observation status. I want to be billing correctly; help me ..... Thanks in advance.
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If the patient is not an "inpatient" nor has she been admitted for observation, you bill an outpatient E/M code for ob triage. You would not bill an ED visit code unless the ob triage unit also sees any patient with any condition and any gender.
 
nielynco said:
If the patient is not an "inpatient" nor has she been admitted for observation, you bill an outpatient E/M code for ob triage. You would not bill an ED visit code unless the ob triage unit also sees any patient with any condition and any gender.
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My provider also seen one of patient in triage on the labor and delivery and abscess. I would code 99213 and place of service 22 Outpatient hospital correct.
 
nielynco said:
If the patient is not an "inpatient" nor has she been admitted for observation, you bill an outpatient E/M code for ob triage. You would not bill an ED visit code unless the ob triage unit also sees any patient with any condition and any gender.
nielynco said:
If the patient is not an "inpatient" nor has she been admitted for observation, you bill an outpatient E/M code for ob triage. You would not bill an ED visit code unless the ob triage unit also sees any patient with any condition and any gender.
Click to expand...
Hi! If patient is sent to ob triage from an office visit,(example. fetal heart rate abnormal, sending to labor and delivery at the hospital for BPP) would this apart of the global period? or is it the E/m visit?
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nielynco said:
If the patient is not an "inpatient" nor has she been admitted for observation, you bill an outpatient E/M code for ob triage. You would not bill an ED visit code unless the ob triage unit also sees any patient with any condition and any gender.
Click to expand...
Can you call out the section that refers to what your translating from this section in ACOG... it's Still gibberish to me and im having a hard time finding where this section is that your speaking to.
 
chevytalle@gmail.com said:
Can you call out the section that refers to what your translating from this section in ACOG... it's Still gibberish to me and im having a hard time finding where this section is that your speaking to.
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The ACOG article does not deal with coding. CPT guidelines for ED visits state ED services are provided in a hospital-organized department for this provision of emergency services 24/7. In order to be accredited, a hospital ED must abide by the federal law which means it is open 24/7 and cannot discriminate by diagnosis, insurance, sex or age. As OB triage units normally only see pregnant patients, it cannot meet this requirement and hence is NOT an ED and the ED codes cannot be reported for the services they provide.
 
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