Q&A: Coding labor and delivery services in hospital outpatient departments

Wednesday, February 20, 2019

Q: We recently had a consultant recommend that we create evaluation and management (E/M) levels for our labor and delivery observation cases, similar to our emergency room levels. Does anyone do this? If so, would you be willing to share your criteria and logic used?

A: I do not believe this situation meets the definition of observation because the E/M assessment is performed to determine whether the patient is in active labor, not to figure out what is wrong with the patient. A good way to manage these cases is to charge the labor check with an E/M code or outpatient hospital visit code G0463, but the hourly labor monitoring has no HCPCS code and is reported under revenue code 0720. The National Uniform Billing Committee says this revenue code does not require a HCPCS. If the labor check E/M is also under revenue code 0720, then the labor check and the hourly labor monitoring can all sum up to a unit of one on an outpatient claim if the patient is discharged as an outpatient.


Editor's note: This question can be found in the Billing and Claims category on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. This question was answered by Valerie Rinkle, MPA, regulatory specialist for HCPro in Middleton, Massachusetts.