Wiki Obgyn er coding

[samantha Martel]

We are an obstetrics clinic and we have been having trouble getting reimbursed for ER visits. We have tried billing observation codes, office visits and consultations. Does anyone have any experience with this? We are never the first DOC that see's the pt so we can't bill a normal ER visit. Please help!

 

[ajs]

We are an obstetrics clinic and we have been having trouble getting reimbursed for ER visits. We have tried billing observation codes, office visits and consultations. Does anyone have any experience with this? We are never the first DOC that see's the pt so we can't bill a normal ER visit. Please help!

Be sure you are using the POS code 23 for ER. Generally you will be using just the outpatient E/M code. Observation codes usually are not used in the ER if the patient is being monitored for possible labor. Those would be POS 22 or 21. Also be sure your diagnosis codes clearly indicate the medical necessity for the visit. If these visits are for OB pts you may have use a modifier 24 to indicate the visit is not part of the global OB care. When all else fails send in the documentation from the visit and appeal.

 

[samantha Martel]

Thank you AJS for your response. So where this gets complicated for me is that sometimes the ER sends the patient up to L&D prior to evaluating them, so we are actually seeing the patient on L&D. Would we use the 21 or 22 POS in this case with the 9921_ and a 24 modifier? I appreciate all of your help.

 

[ajs]

Thank you AJS for your response. So where this gets complicated for me is that sometimes the ER sends the patient up to L&D prior to evaluating them, so we are actually seeing the patient on L&D. Would we use the 21 or 22 POS in this case with the 9921_ and a 24 modifier? I appreciate all of your help.

You would probably use 21, unless they don't stay a full day then it may be 22 for outpatient. Just depends on each situation. I know what you mean I have done OB coding for a long time!