Ob-Gyn Coding Alert

Question: We had a new patient scheduled for a well-woman exam, and she arrived at the office almost five months pregnant. What type of service should the doctor provide at that time and how should that be coded? Is that first visit part of the global ob care because she is that far along?
 
Is there such a thing as a well-woman exam on a pregnant patient? Do we have to confirm the pregnancy if she comes with no other medical documentation of her pregnant state? Would it be any different if she were only one or two months pregnant when she came to the office for a well-woman exam?

Alabama Subscriber  
Answer: In this case, there is no such thing as a well-woman exam on a very pregnant patient because the initial history and physical performed on a pregnant patient, the one that is included in the global ob package, is by definition a comprehensive service and will include a Pap smear. It would not make any difference how far along she is in her pregnancy.
 
A preventive service (99381-99387) can be billed outside the global only if this is a planned annual exam and she has just become aware of the pregnancy via a home pregnancy test or you confirm pregnancy at the time of visit (assuming she is complaining of a missed period or irregular periods).  
Answers to Reader Questions and You Be the Coder provided by Melanie Witt, RN, CPC, MA, an independent coding consultant and ob/gyn coding expert based in Fredricksburg, Va.