Ob-Gyn Coding Alert

A pregnant patient moves out-of-state mid-pregnancy. Do you know how to report the services your ob-gyn provided up to the date of the move? Prepare for these situations by adopting the following approaches based  on the number of visits.

If your ob-gyn sees a patient for only one, two, or three antepartum visits, you need to report the appropriate E/M codes to be reimbursed, says Tracy Anderson, CPC, credentialing/coding specialist for ACMH Physician Services in Kittanning, Pa.

Pitfall: For the first ob visit, don't automatically look at a level-four established patient visit (99214, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity ...). You won't have a set E/M code for the patient's first visit, because your patient could be new to the practice, for example, or the first visit may actually meet the criteria for a level-five established visit. Therefore, you should look to the entire code series (99201-99205 for new patients, 99211-99215 for established patients) as possible options.

For the second and third visits, your coding options are more limited. Medicare valued the follow-up visit as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...), but be sure your ob-gyn's documentation supports the code level you select.

You may have rare circumstances where the patient has absolutely no problems during the visits. In those cases, you may instead only have 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...Physicians typically spend 10 minutes face-to-face with the patient and/or family) for each visit.

If the patient's pregnancy is without complication, your diagnosis would be either V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy).

Four to six total visits means that you'll be flipping through your book to the maternity care and delivery section -- particularly the antepartum codes. You should report 59425 (Antepartum care only; 4-6 visits), a code that represents the total services rendered by your ob-gyn.

You'll only report one unit of this code.

Your diagnosis will be the same -- V22.0 or V22.1 -- unless the patient has any problem or complication.

You'll find more variation in your coding choices if your patient leaves your practice after seven or more visits. CPT has a code specifically for seven or more visits: 59426 (... 7 or more visits). You can report one unit of 59426 with diagnosis codes V22.x through V23.84, as appropriate.

Error averted: Avoid reporting global codes at all costs. You can report a global code only if your ob-gyn also does the delivery. Because you're talking about a patient who leaves the practice before delivery, codes 59400-59622 do not apply.

Caution: Some payers may ask you to report each visit separately -- and you may want to ask your representatives how the policy defines "separate." "Separate" may mean reporting 59426 along with a list of the dates. This is why you should definitely keep track of a patient's prenatal visits by noting the date the ob-gyn sees the patient.

The payer also may want you to report the appropriate E/M code for each visit, but that isn't likely. "In the past, a payer has requested that we report these visits separately.

We copied the explanation of the CPT code for 59425 and 59426 from the book and forwarded it back to the payer -- and haven't heard another word or request since," says Terri R. Viar, CPC-A, an ob-gyn coder at Women's Care PA in Shawnee Mission, Kan.