If the patient delivers within 24 hours of the admit then you cannot charge the E&M and the prolonged codes. If the labor is excessive and the provider is in attendance the entire time you can bill the global code with a 22 modifier: In the code definitions for global care, the word “routine” is an important distinction.When a physician spends extra time and management with a patient, attach modifier -22 to the global ob code.Patient should not be receiving oral vitamin K inhibitor (eg, warfarin, Coumadin), heparin, low molecular weight heparin, hirudin (Refludan), argatroban, fibrinolytic agents (eg, streptokinase, tissue plasminogen activator) for optimal results.
Times are listed for each service in the CPT manual only as a guideline.
On the other hand, CPT lists a variety of codes that are strictly time dependent and even has codes for prolonged services.
However, I believe it is reasonable to think of the time guidelines listed in CPT not as thresholds but simply as averages to help you select the most appropriate code for the time spent.
Under this interpretation, physicians’ actual time spent (either face-to-face or floor/unit) should be rounded either up or down to the nearest average.
Determining cause of prolongation of prothrombin time or activated partial thromboplastin time Screening for prolonged clotting times and determining the presence of factor deficiency(ies) or inhibitor (factor-specific, lupus-like, or the presence of heparin)Initial testing includes: prothrombin time (PT), activated partial thromboplastin time (APTT), dilute Russells viper venom time (DRVVT), thrombin time (bovine), fibrinogen, D-dimer, soluble fibrin monomer, and special coagulation interpretation.
If PT is When coagulation screening tests are performed to verify normal function of the coagulation system (eg, preoperative, routine examination), they sometimes indicate an abnormality that may be unexplained (ie, prolonged clotting times).Whatever the complications of labor process, they are contained within these modes of delivery CPT codes.The labor course may be spontaneous, precipitate/spurious(early) or prolonged labor. The prolonged labor may be in one of these stages of labor : first or the second stage or both.If you are using the admit E&M with the prolonged codes the provider must be with the patient the entire time, if the delivery does not occur within 24 hours then some payers will allow you to bill the admit, and some will not.However rarely have I observed a provider in attendance with a patient for the entire duration of the labor, so be certain the documentation is very explicit.“The modifier indicates a level of service greater than ‘the norm,’” Callaway says, “but physicians will still have to explain the extra work that was done.” The modifier requires a detailed note from the obstetrician that explains rule “ins” and rule “outs” and describes the level of risk to patient and fetus.