Ob-Gyn Coding Alert


3 Questions Clarify Your Confirmatory Visit Claims

If you start the ob record too soon, you’ll miss out on E/M reimbursement.

A patient has taken a pregnancy test at home and your ob-gyn simply confirms the pregnancy, so you should automatically begin the global record, right? Wrong. You could be missing out on $40-$60 per visit.

Test your ob record skills with the following three questions.

3 Questions Challenge When to Start Ob Record

Question 1: The ob-gyn sees a patient who knows that she’s pregnant via a positive home pregnancy test and simply “confirms the confirmation.” When should you start the ob record?

Question 2: A patient comes in for an annual exam, and the ob-gyn diagnoses pregnancy. When should you start the ob record?

Question 3: A patient sees your ob-gyn after her family physician discovered that she’s pregnant and wants to have her ob care with your practice. She has been seen by your practice within the last 12 months. When would you start the ob record?

Treat Positive Home-Test Cases Like This

Answer 1: Start the ob record at the next visit. If the ob-gyn performed only the urine pregnancy test, you’d report 81025 (Urine pregnancy test, by visual color comparison methods) or possibly a low-level E/M service (such as 99201-99202 for new patients or 99211-99212 for established patients) if some discussion about her health took place.

You will use Z32.01 (Encounter for pregnancy test, result positive) when your ob-gyn simply tests to see if the patient is pregnant. Because you’ll be coding for what you know at the end of the visit if it is more specific than her presenting reason, this code will go on both the E/M code and the urine test.

Attack Annual Visit, Pregnancy Scenario

Answer 2: In this scenario, you should start the ob record at the next visit. The patient was here for her annual exam, not to start care for her pregnancy.

If you began the ob record during the annual exam visit, most carriers will consider the annual exam part of the global ob service. You cannot bill the global service until delivery, but you should inform the insurance company of the pregnancy.

Rule of thumb: Until you know that the patient wants her pregnancy to continue, you shouldn’t initiate the global care.

Previous Physician Diagnosis Changes Situation

Answer 3: Initiate the ob record during this visit. The patient is here to start her ob care. Because another physician made the diagnosis, your ob-gyn probably wouldn’t need to confirm the confirmation. Therefore, he would begin the ob record, which means this service is part of the global ob package.

What’s involved: The ob coordination is lengthy, usually lasting 30 minutes or more, and involves going over procedure guidelines, including a timetable of when to do lab tests, pelvic exams, amniocenteses, etc. The ob-gyn will usually provide vitamins and iron supplements and discuss when to call him.

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