Ob-Gyn Coding Alert

Editors Note: Last months case focused on the patient with multiple visits to address the problem of infertility. This month we focus on the problem of coding for pregnancy testing and office visits. To do so we continue the case of our 27-year-old patient who had been unable to conceive after more than one year of intercourse without contraception. She had been put on clompiphene citrate for six cycles, which was followed by menotropins therapy. She has now missed a menstrual period and returns to the reproductive endocrinologist to confirm pregnancy.

To recap, during our patients last visit to the reproductive endocrinologist on May 30, she had an ultrasound that confirmed that she was ready for her injection of hCG and this was administered at that visit. A progesterone blood test was done to confirm ovulation 24 hours after the hCG injection at the outpatient lab. At that point, the patient is instructed over the phone on when and how often to have sexual intercourse. She is instructed to call the office if she has a normal period, or to make an appointment for confirmation of pregnancy if her period has not started after June 21. Happily, our patient misses her period and comes in to confirm pregnancy. She sees the endocrinologist on June 15 where a pregnancy test is performed. On June 17 she comes in to learn that she is pregnant and to determine what will happen next. At this visit, she also has a repeat hCG drawn to correlate the results of the previous test. The physician calls the patient the next day to confirm pregnancy and tells her to make her first appointment with her obstetrician.

Coders Notebook

The patients first visit, after missing her period, on June 15, is to confirm pregnancy. This visit might be billed as a level 2 or 3 office encounter, depending on whether the visit was controlled by history/exam/medical decision-making or by counseling (that is, the level is selected by documented counseling time).

There are basically three choices for billing the pregnancy test or a part of it.

1. If the office sends the test out to an independent lab, but bills for the service on behalf of the lab, the office bills for the laboratory service by adding a modifier -90 (reference [outside] laboratory) to the lab code.

2. If your ob/gyn office has a laboratory qualified to perform the pregnancy test, no modifier -90 would be added to the lab code reported. In either of these two instances, however, a blood draw would probably not be reimbursed separately by the payer, because many carriers roll this part of the service into the allowable for the test.

3. If, however, [...]