Ob-Gyn Coding Alert

Editors Note: This months case comes from a compilation of many questions that Ob-Gyn Coding Alert has received regarding correct coding for ob patients who require more care than that which is included in the global ob billing.

Angela, a hypothetical new 25-year-old patient, presents with a complaint of being late for her period. The usual pregnancy test is performed, and she is diagnosed as 8 weeks pregnant with the physician noting gravid 1, para 0. She is scheduled to be seen monthly until 28 weeks gestation and biweekly until 32 weeks gestation. At 10 weeks, because of light spotting she presents for a visit other than her monthly visit. At 21 weeks, she presents again for an extra visit and is diagnosed and treated for a urinary tract infection (UTI).

When Angela presents for her 32-week visit, she is found to have developed mild hypertension. To ward off preeclampsia, the ob/gyn prescribes bed rest, and Angela is managed expectantly with weekly visits through 39 weeks gestation. Four days after her last visit, she vaginally delivers a healthy seven-pound boy. The postpartum course is uneventful, and she is discharged after her six-week visit.

The question is: how do you correctly code for maximum reimbursement for the ob patient who has extra visits and mild complications during her antepartum care?

Terminology and Procedure

1. Terminology. While the terminology of basic obstetrics is well-understood by most ob-gyn coders, we will review several items:

Gravid 1, para 0 is the medical terminology that provides a ratio of the number of pregnancies a woman has had to the number of viable-size deliveries. The gravid number refers to all of pregnancies a woman has had regardless of how long she carried the fetus or whether or not she miscarried or aborted. Para refers to the number of deliveries of viable size (over 500 grams) a woman has had.

Hypertension during the course of a pregnancy is sometimes referred to as pregnancy-induced hypertension (PIH). ACOGs committee on terminology has suggested that hypertension should be defined as a rise of 15 mmHg diastolic and a rise of 30 Hg systolic blood pressure, or a systolic blood pressure value of 140 mmHg over a diastolic blood pressure of 90 mmHg, with blood pressure values obtained on two occasions at least six hours apart.

Preeclampsia is usually diagnosed in the pregnant patient after 20 weeks when there is a presence of hypertension, edema or water retention, and elevated protein in the urine (proteinuria).

2. Procedures/services. There are no unusual procedures in this case, but the coder will want to note which provided services are included in, and which are outside, the normal definition of uncomplicated maternity care and delivery. Normally provided [...]