OB Triage Coding and Billing Guidelines

ShawishihaynesShawishihaynes
in BILLING AND CLAIMS

Dear Colleagues,

How are folks coding and billing for OB Triage Encounters:

Scenario 1: Patients that come in through the ER check in and are sent to OB Triage (outside of the ED)

Scenario 2: Patients that come in through the ER (do not check in to the ED) and are sent directly to OB Triage on the unit

Scenario 3: Patients that come in through other hospital entry points and go directly to OB Triage.

What specific coding rules and guidelines are you following? There are no consistent guidelines that we are finding.

Comments

  • trositrosi

    No matter which entry point is used [3 scenarios above], patients are assigned urgent care vs. non-urgent care based on presenting condition/complaint. We then charge/bill urgent care visits in rev code 456 and we charge/bill non-urgent visits in rev code 510. We have simple/intermediate/complex levels defined by type of service provided for each.

  • ShawishihaynesShawishihaynes

    Thank you. May I ask what EMR do you have?

  • trositrosi

    We use Epic

  • kay.larsen@ah.orgkay.larsen@ah.org

    Trosi, do you get denials for the 510 rev code?

    Our patients are also sent to OB Triage and we bill an E&M visit code but constantly get denied by commercial insurances because of the 510 rev code. Are you experiencing the same thing? If not, what is your secret to not being denied?

    Thanks!

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