Ob-Gyn Coding Alert

To get reimbursed appropriately for the new drug Mifeprex, ob/gyn coders need to know the details of each stage of the three required visits, as well as the importance of thoroughly documenting the face-to-face time with the patient.

In late September of last year, the Food and Drug Administration (FDA) approved Mifeprex for use in non-surgical abortions in the United States. (See Special Report on RU486 Coding, an insert in the October 2000 Ob-Gyn Coding Alert.) Since then, physicians, insurance companies and politicians have adjusted and responded to this product, which changes the landscape of legal abortion in the United States. Our original article on Mifeprex coding outlined the three stages of administering the drug and how to code for them. The patients first visit, assuming she has decided to terminate the pregnancy, involves extensive physician counseling on the use of the drug. At the initial visit, many physicians will conduct an ultrasound (although not required by law) to most effectively date the pregnancy (to make sure the pregnancy is less than 7 weeks old). Upon complete evaluation, the Mifeprex is administered orally and the patient goes home. Visit one is coded:

99204 or 99214 office or other outpatient visit for the evaluation and management of a (new or established) patient ...;

76805 echography, pregnant uterus, B-scan and/or real time with image documentation; complete (complete fetal and maternal evaluation); or

76815 echography, pregnant uterus, B-scan and/or real time with image documentation; limited (fetal size, heart beat, placental location, fetal position, or emergency in the delivery room); and

J8499 prescription drug, oral, nonchemotherapeutic, not otherwise specified, or 99070 supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided).

The second visit occurs two days later, and the patient is given two tablets of Misoprostol, the companion drug to Mifeprex necessary to complete the non-surgical abortion. This visit is coded for both an evaluation and management (E/M) service and the drug supply:

99213 or 99214 office or other outpatient visit for the evaluation and management of an established patient ...; and

J8499 prescription drug, oral, nonchemotherapeutic, not otherwise specified; or

99070 supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided).

The third and final visit takes place 12 days after the second visit, to determine that the non-surgical abortion is complete and there are no complications. Assuming there are no complications, an E/M service is the only billable aspect of the encounter and is coded:

99213 or 99214 [...]