L & D Observation Leveling (E&M)

edited January 23 in BILLING AND CLAIMS
We recently had a consultant recommend that we create E&M Levels for our Labor and Delivery Observation Cases, similar to our ER Levels.  Does anyone do this?  If so, would you be willing to share your criteria and logic used?


  • I believe that a facility level charge would not be applicable for a patient in observation status because you would be charging that patient for the room by the hour. Facility E & M charges would be applicable to a patient coming in and being seen as an outpatient. The level system would only be applicable if the patient is visiting with a doctor and she/he documents a note for the visit, nurse would document the assessment, vital signs, etc. to support hospital resources.
  • A good way for L&D checks 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.  NUBC says this revenue code does not require 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 1 on an outpatient claim if the mom is discharged as an outpatient.  I also agree that this situtation does not meet the definition of observation because the assessment is whether the patient is in active labor, not to figure out what is wrong with the patient.
  • Agree with Valerie. Our recommendation was for the units to define services that did not have an applicable CPT or HCPCS to report and define time taken to perform. They them created levels that reflected time spent performing the tasks and looked at resource consumption for the levels and priced according, assigning G0463 for Medicare and the E/Ms for other payors.
  • Do you have a cdm item for a mother who delivered outside the hospital?
  • We don't have a charge if the delivery was prior to arriving at the hospital but if we delivered the placenta, we post a charge for CPT 59414.

  • Our pregnant patients coming in through ED are immediately sent to L&D for triage.  No ED charges are posted.  Would we be able to use ED Level charges in this scenario?
  • Deb - are you referring to starting an OB ED at your facility?

  • OBS- we charge by the minute and the minutes convert to hours on the claim

    OP in a bed- we charge by E/M or G0463... we use 456 for urgent care/assessment visits and 510 for non-urgent care visits. The determination is based on presenting complaint/condition that is being evaluated and managed by the triage team.

  • We also had a vendor come in and created a matrix for charging E&M visit charges for the time before the observation order was entered so we have both charges on an account. However, almost all of our E&M visit charges are denied by our commercial payors.

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