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INTRODUCTION

In an OB/GYN hospitalist practice, there are many challenging medical and billing situations routinely encountered. Coding and billing for these scenarios, documenting properly, submitting to third-party payers, and getting appropriately reimbursed are integral to keeping an OB/GYN hospitalist practice solvent and thriving.

At this time in the OB/GYN hospitalist specialty, there are many practice and billing models to choose among, and determining which one is right for your practice can be confusing. In addition, OB/GYN hospitalists encounter patients who do not have access to or have not chosen to see a traditional obstetrician to oversee their care. Many patients also rely on the OB/GYN hospitalist to respond to emergencies and care for them around the clock. In many instances, traditional OB/GYN providers consult with hospitalists to augment and provide specialty, hospital-based services for high-risk patients. The OB/GYN hospitalist program concept is new in the United States. Coding and billing for this subspecialty pose a bigger challenge for providers, hospitals, and coding/billing staff. OB/GYN hospitalists are bearing the burden of maintaining above-standard specialty patient care, while remaining fiscally solvent.

OB/GYN hospitalist programs have a positive impact on high-risk obstetric healthcare because they enable patients to have emergent attention when their own physician is unavailable. Of course, hospitalists provide many other functions, such as supporting local obstetricians as backups for deliveries and emergency cesarean sections (C-sections), providing ancillary testing services for walk-in or emergent trauma situations, and stepping in as assistant surgeons for many operative procedures.

The fiscal mainstay for the OB/GYN hospitalist practice is evaluation and management (E&M) services. These 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 Current Procedural Terminology (CPT) codes provide an enormous source of revenue. These codes include surgery; interventional, diagnostic, and therapeutic medicine; and radiology/ultrasound services. Not only does an OB/GYN hospitalist team provide these services but it is also instrumental in leading to “downstream” revenue that ultimately benefits healthcare facilities, such as laboratory, radiology, neonatal intensive care unit (NICU), pharmacy, nutritional, and social work services.

Each OB/GYN hospitalist program functions under different licenses within the hospital setting. Some practices are embedded with the emergency room (ER), some are an integral part of the Labor and Delivery (L&D) floor, and others operate as an emergent outpatient area of the hospital, similar to a quick-care or urgent-care walk-in clinic. The most common structure includes the OB/GYN hospitalist stand-alone practice that functions as a separately identifiable group and bills as a physician-based practice team. They usually code and bill with their own management software, coding/billing team, or both.

Coding and billing in an OB/GYN hospitalist practice is a specialty concept within itself. The OB/GYN hospitalist practice has to provide superior care not only for the pregnant patient but also for the fetus. Many times ...

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