Wiki Billing an E/M during a sched. OB visit


Puyallup, WA
Best answers
Would someone please calrify...
I was under the impression if a pregnant patient is in for her routine pre-natal visit BUT had symptoms or a problem that required additional work up that we could bill the appropiate E/M and DX...

I was told that because the pt was in for her prenatal visit that we could NOT bill? seems a little odd as the work up for the problem is not encompssed in the definition for the "antepartum care"

any help or suggestions would be appreciated!

Thank you!:confused:
E/M during prenatal visit

When I worked for OB, we did this often. If mom comes in for her regular monthly prental visit but complained of and was treated for an ear infection for example, we 'split billed' the visit. The prenatal was keyed as 94999 for our system to record and apply towards the global OB fee, and then we billed a separate E/M for the ear infection to insurance. You can bill for the workup/exam that not's pertaining to reg. OB care as an EM. Hope this helps!!

Kristina CPC, CANPC
how would you code the ear infection

if the patient is pregnant and she has an ear injection, would you code the ear infection as primary or use a pregnancy complication code primary followed by the ear infection code? if this is not a routine ob visit

Karrie, CPC
Unless the provider documents that the problem is not complicating the pregnancy you must use a Chapter 11 code first listed. So it would be a 648.93 first and the ear infection second. Chapter 11 codes have sequencing priority and are always first listed. Check this in the coding guidelines.
Ok thank you, this is what I suspected. Our clinic is currently having a controversy over this matter. The insurance bill is saying the 648.93 is not suppose to be added. I always have added it because doumentation doesn't state that it is not a prengancy complication.