Monday, February 20, 2017

Overview: Coding and Billing in an OB Hospitalist Practice

Coding and Billing in an OB Hospitalist Practice

In an OB Hospitalist practice, currently there are many different medical and billing scenarios each and every day that bring challenges.  Coding and billing for these scenario’s, and how they are documented, submitted to 3rd party payers, and the reimbursement back to the practice is integral to keeping an OB hospitalist practice solvent and thriving. 

At this time in the OB hospitalist specialty there are many different practice and billing models to choose from, and determining which one is right for your business can be confusing.  In addition, OB hospitalists encounter patients who don’t have access to,  or have not chosen to see a traditional OB or health care provider to oversee their care.  Many patients also rely on the OB hospitalists to respond to their emergencies and care for them around the clock.  

In many instances, we are now the go-to for traditional OB/GYN providers to augment and provide specialty hospital based services for high risk and trauma ob and GYN patients.  The OB hospitalist program concept is fairly new to the American hospital system, and coding and billing for this subspecialty poses a bigger challenge for the providers, as well as the hospital and coding/billing staff.  OB hospitalists are bearing the weight of maintaining above standard specialty patient care, in addition to being fiscally solvent.

The OB-GYN hospitalist program has a positive impact on at-risk OB patients’ health care because these programs enable the patients to have emergent care for any type of OB or GYN emergency when their own physician is unavailable on a 24/7/365 basis.  

Of course, we provide many other functions such as, supporting local obstetricians as back-up for deliveries and emergency C-sections; providing ancillary testing services for walk-in or emergent trauma situations, and also step in as an assistant surgeon for many operative procedures at a moment’s notice.  (that may or may not be OB related)

The fiscal mainstay for the OB Hospitalist practice is evaluation and management (E/M) services, which include all areas of inpatient hospital, outpatient hospital, emergency department, critical care, complex care management, and office-quick/urgent care coding.  In addition to the evaluation and management codes, procedure based CPT codes provide an enormous source of revenue, which can include surgery, interventional, diagnostic and therapeutic medicine, radiology/ultrasound services.  Not only does and OB hospitalist team provide these services, but are instrumental in also providing “down-stream” services that can impact a facility in a positive way, such as laboratory, radiology, NICU, pharmacy, nutritional services, social work services, and other areas within the facility that would not have had these financial opportunities had the OB hospitalist team not been in place.   

Each OB hospitalist program functions under many different licenses within the hospital setting.  Some practices are embedded with the Emergency Room, some are an integral part of the Labor & Delivery floor, while others operate as a “emergent outpatient” area of the hospital similar to a “quick-care, urgent-care” walk in clinic.  The most common is the OB hospitalist physician team is a “stand alone” practice comprised of OB hospitalist (specialty) physicians that function as a separately identifiable group practice that bills as a physician based practice team utilizing and coding and billing with their own practice management software and/or coding/billing team. 

Coding and billing in an OB hospitalist practice is a specialty concept within itself.  The OB hospitalists practice specialty has to provide superior care not only for the pregnant patient, but for the fetus too.  During routine coding and billing audits, many times the “hish risk” factor is overlooked or undervalued during the “scoring”  when determining the evaluation, plan of care, clinical documentation, risk factors, proposed procedures and ancillary services options when coding and billing is performed.

The nuts and bolts of traditional CPT evaluation/management and procedure codes are utilized in addition to the current ICD-10cm diagnosis codeset. Clinical documentation by the OB hospitalist is integral to success when the coder/biller has to combine all these pieces together for the evaluation and management code, the procedures performed, diagnosis, ancillary circumstances (eg pt fell, etcc) are relevant to report for reimbursement for services provided.  

The coding and billing for the OB hospitalist team should be one of your primary areas of concern as this will be the key to a successful practice.  Education in coding, billing and clinical documentation  for the entire OB hospitalist practice should be one of the important areas to review and consider, as you implement a new practice, or work to renew or revitalize a practice that is struggling with a financial issue.

Commonly coded/billed CPT Procedures
Ob Hospitalist Procedures:

·         59050/51          Fetal monitoring (IUPC)
·         59150/51          Laparoscopic treatment of ectopic pregnancy
·         59120/21          Surgical treatment of ectopic pregnancy
·         58605               Ligation or transection of fallopian tube(s),  during same hospitalization
·         58611               Tubal Ligation (Add on w/c-section)
·         59025-26           Fetal NST interpretation
·         59160               Curettage - Post Partum
·         59200              Insertion of cervical dilator
·         59300               Episiotomy or vaginal repair, by other than attending physician
·         59320               Cerclage of cervix
·         59409               Vag Deli Only
·         59412               External cephalic version, with or without tocolysis
·         59414               Placenta only delivery
·         59514-80           Assist to a surgeon for cesarean delivery
·         59514               Cesarean delivery only;
·         59525               Hysterectomy (post cesarean delivery)
·         59612               V-back delivery
·         59618               Cesarean post failed attempted vback delivery
·         59899               CPT “unlisted” services such as Bakri Balloon hemorrhage care             
·         76815               Bedside quick-peek Ultrasound
·         76818/19          Fetal Bio-physical profile(s)
·         76998               Intraoperative ultrasound

Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience.  Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding.  She can be reached via e-mail at or you can also find current coding information on her blog site:   

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