Ob-Gyn Coding Alert

Are you starting the ob package too soon? Don't miss out on the $37.15 your ob-gyn deserves when your ob-gyn sees a patient for a nonscheduled (or non-annual) visit and determines she is pregnant.Undertake this three-scenario challenge to decide whether you'll begin the global package (59400, 59510, 59610, or 59618) or count the visit as separate.

Scenario 1: The patient sees her ob-gyn for abdominal cramping, sweating, having missed a period, or for other possible symptoms. These complaints prompt the ob-gyn to order a pregnancy test (like 81025, Urine pregnancy test, by visual color comparison methods). He learns from the results that she is pregnant.

You should report an E/M service (for example, 99212, Office or other outpatient visit for the evaluation and management of an established patient..., which includes two of three of problem-focused history and examination, straightforward medical decision making) because the symptoms are related to a problem that turned out to be pregnancy.

Does global ob package start? No. If the ob-gyn evaluated other possible problems (that eventually revealed the pregnancy), you should report this service outside the global ob package. That's a $37.15 addition to your bottom line.

You should still report the pregnancy finding (V72.42, Pregnancy examination or test, positive result) by attaching it to the lab test for pregnancy. Caution: Make sure the documentation clearly details how the ob-gyn did not see the patient for pregnancy but for other symptoms, says Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.

Scenario 2: If the patient comes in with complaints and thinks she might be pregnant (she has taken a home pregnancy test), the ob-gyn will determine whether these complaints relate to the pregnancy. Similarly, she may present because another provider suspects or has confirmed that she is pregnant.

Does global ob package start? Usually, Witt says. If these complaints do relate to her being pregnant, you should code the service as part of the global ob package if the ob-gyn initiated the record during this visit.

"If the chief complaint of the patient -- or in other words, the signs and symptoms -- was because the patient is pregnant, then the ob record would begin," says Lynn M. Anderanin, CPC, CIMC, senior coding consultant for Health Info Services in Park Ridge, Ill. If your ob-gyn initiates the ob record during that visit, the entire visit becomes part of the global period.

Note: Many practices do not accept home pregnancy tests and require a test from the patient's primary care physician or other medical source.

Scenario 3: The same patient arrives knowing that she is pregnant because her home pregnancy test was positive. If the ob-gyn simply "confirmed the confirmation,"you should code "by the method used to confirm the pregnancy," Anderanin says. This method might include either the urine pregnancy test (81025) if the ob-gyn performed one or a low-level E/M service (such as 99212) if some discussion with the patient took place.

Does global ob package start? No. The pregnancy is not being managed at this visit. The provider is just confirming the diagnosis but is not starting the ob record at this visit, Witt says.

Note: To find solutions to annual visit scenarios, refer to "Pregnancy Dx During Annual Does Not Mean Global Care Begins" in Ob-Gyn Coding Alert, Volume 12, Number 11.