Ob-Gyn Coding Alert

Here's what to do if your payer requests separately reporting each visit Think you can handle situations where a pregnant patient moves out-of-state mid-pregnancy? Prepare for coding your ob-gyn's services up to the date of the patient's move depending on how many antepartum visits the physician provides -- either one to three, four to six, or seven or more. 1-3 Visits Mean Office E/M Codes Scenario: Your ob-gyn sees a pregnant patient for only one to three antepartum visits. How should you report this? Solution: You need to report the appropriate E/M codes for payment. First visit: 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 two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity), says Janine Snyder, billing supervisor at Desert Women's Health Care in Henderson, Nevada. You won't have a set E/M code for the patient's first visit. Your patient could be new to the practice, or the first visit may 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. Second and third visits: Your coding options are more limited for visits two or three. Medicare values the follow-up visit as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...), so this code is your best bet for each of these visits in the absence of documented problems. Heads up: In some rare circumstances, such as when the patient has absolutely no problems during the visit, however, the documentation might support reporting only 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). Watch out: Because you do not have a specific antepartum code for one to three visits and have to report E/M codes, payers sometimes will deny these claims and tell you to "include in the global." You are "forced to appeal these decisions," Snyder says. Explain to the payer that you cannot report a global code because you are no longer the patient's OB care provider. 4-6 Visits Mean Antepartum Code Scenario: Your ob-gyn sees a pregnant patient for four to six antepartum visits. How should you report this? Solution: Four to six visits means you-ll be flipping through your book to [...]