Ob-Gyn Coding Alert

Three scenarios help illuminate what code you should report.

When a patient sees her ob-gyn for a nonannual examination visit and learns she is pregnant, you need to adhere to the golden rule: code what you know at the end of the visit.

When Nonscheduled Visit Determines Pregnancy

Follow these three scenarios, and you'll know when to start the global ob record.

Scenario 1: The patient sees her ob-gyn for abdominal cramping, sweating, having missed a period, or 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.

Solution 1: You should report an E/M service (for example, 99212, Office or other outpatient visit, established patient, problem-focused history and examination, straightforward medical decision-making) because the symptoms are related to a problem that turned out to be pregnancy. If the ob-gyn evaluated other possible problems (which eventually revealed the pregnancy), you should report this service outside the global ob package.

You should still report the pregnancy code (V72.42, Pregnancy examination or test, positive result) by attaching it to the lab test for pregnancy, but make sure the claim clearly details that the ob-gyn did not see the patient for pregnancy but for other symptoms.

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.

Solution 2: 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 patient's chief complaint -- in other words, the signs and symptoms -- is caused by the pregnancy, then the ob record would begin, experts say. If your ob-gyn initiates the ob record during that visit, the entire visit becomes part of the global period.

Scenario 3: The same patient arrives knowing that she is pregnant because her home pregnancy test was positive.

Solution 3: If the ob-gyn simply "confirms the confirmation," you should code by the method used to confirm the pregnancy. This method might include either the urine pregnancy test (81025) if the ob-gyn performs one or a low-level E/M service if some discussion about the patient's health takes place.

ICD-10: When your diagnosis coding system changes, V72.42 will become Z32.01 (Encounter for pregnancy test, result positive).