Coding Question of the Month

January Coding Question of the Month: Is it correct to bill an emergency department service code when I see/evaluate my patients in a triage bed inside a 24/7 hospital OB triage?

Answer:

Recently, ACOG has received several inquiries about billing for services provided in a 24/7 hospital OB triage area. In order to properly bill for emergency department services, you must first determine whether the OB triage has been designated as an ER by the hospital. If not, you should report the appropriate office visit or other outpatient visit code since the OB triage is considered an outpatient portion of the hospital. 

CPT defines an emergency department as “an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day.” The level of service for emergency department service codes (99281-99285) requires that all three key components (history, exam, and medical decision-making) be performed and documented. 

In general, you may bill as high—if not higher—with an office visit code without having to perform all three key components. Please see the 2018 Relative Value Unit (RVU) comparison chart below. For example, an established patient visit only requires two of the three key components.

To view the complete Coding Question of the Month archive, please visit our Freshdesk Solutions page. 

Contact:

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Donna Tyler
Director, Coding
dtyler@acog.org

Joyce Kilgore
Facility Coding Education Specialist
JKilgore@acog.org

Miroslava Rudneva
Coding Education Specialist
MRudneva@acog.org

Tatyana Mallory
Facility Coding Education Specialist
TMallory@acog.org

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