Wiki billing before initial ob visit

maddalynni

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Saugus, MA
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Hello,

Our ob/gyn providers often see patients that do their own home pregnancy tests. When they have problems, like spotting and come in for a check before the initial visit is scheduled to establish ob care, the doctors often choose ICD 10 code O36.80X0 inconclusive fetal viability and bill a 99213/99214 and the payer always denies as inclusive to ob care. How can we get paid for this type of visit before initial care is established?
 
My providers generally code the amenorrhea or irregular menstruation and an additional code Z32.01 - encounter for pregnancy test, result positive. They bring the patient back for the initial OB visit and dating ultrasound after they've verified the pregnancy by an in-house pregnancy test. We haven't had any problems with reimbursement.
 
I found useful information on ACOG, updated 11/2020:
QUESTION: How do I report the confirmation of pregnancy visit prior to starting the obstetric package?
ANSWER:
If a pregnancy is confirmed during an office visit for a new or established patient, it is reported with an evaluation and management (E/M) code. The level of service is determined by time or medical decision making. Services such as blood work for laboratory testing and the prescription of prenatal vitamins are permissible during this encounter.
However, if the provider initiated and documented the comprehensive work of an initial antepartum visit in an OB record, that begins the patient’s maternity care during this encounter. The E/M service provided is now considered part of the global obstetric package and is not separately reported.

If a pregnancy has been previously confirmed by a different provider, it is not generally appropriate to report an additional evaluation and management (E/M) initial visit for confirmation. This is not appropriate because there would not be any clear medical necessity for confirming the pregnancy again.

Prior to starting the OB record, when confirming the pregnancy Z32.01 (Encounter for pregnancy test, result positive) is the appropriate diagnosis code to report.
When the OB record is initiated, during the antepartum period for the first pregnancy the following code(s) are appropriate: Z34.-......
 
My providers generally code the amenorrhea or irregular menstruation and an additional code Z32.01 - encounter for pregnancy test, result positive. They bring the patient back for the initial OB visit and dating ultrasound after they've verified the pregnancy by an in-house pregnancy test. We haven't had any problems with reimbursement.
Thank you
 
I found useful information on ACOG, updated 11/2020:
QUESTION: How do I report the confirmation of pregnancy visit prior to starting the obstetric package?
ANSWER:

If a pregnancy is confirmed during an office visit for a new or established patient, it is reported with an evaluation and management (E/M) code. The level of service is determined by time or medical decision making. Services such as blood work for laboratory testing and the prescription of prenatal vitamins are permissible during this encounter.
However, if the provider initiated and documented the comprehensive work of an initial antepartum visit in an OB record, that begins the patient’s maternity care during this encounter. The E/M service provided is now considered part of the global obstetric package and is not separately reported.

If a pregnancy has been previously confirmed by a different provider, it is not generally appropriate to report an additional evaluation and management (E/M) initial visit for confirmation. This is not appropriate because there would not be any clear medical necessity for confirming the pregnancy again.

Prior to starting the OB record, when confirming the pregnancy Z32.01 (Encounter for pregnancy test, result positive) is the appropriate diagnosis code to report.
When the OB record is initiated, during the antepartum period for the first pregnancy the following code(s) are appropriate: Z34.-......
Thank you
 
I found useful information on ACOG, updated 11/2020:
QUESTION: How do I report the confirmation of pregnancy visit prior to starting the obstetric package?
ANSWER:

If a pregnancy is confirmed during an office visit for a new or established patient, it is reported with an evaluation and management (E/M) code. The level of service is determined by time or medical decision making. Services such as blood work for laboratory testing and the prescription of prenatal vitamins are permissible during this encounter.
However, if the provider initiated and documented the comprehensive work of an initial antepartum visit in an OB record, that begins the patient’s maternity care during this encounter. The E/M service provided is now considered part of the global obstetric package and is not separately reported.

If a pregnancy has been previously confirmed by a different provider, it is not generally appropriate to report an additional evaluation and management (E/M) initial visit for confirmation. This is not appropriate because there would not be any clear medical necessity for confirming the pregnancy again.

Prior to starting the OB record, when confirming the pregnancy Z32.01 (Encounter for pregnancy test, result positive) is the appropriate diagnosis code to report.
When the OB record is initiated, during the antepartum period for the first pregnancy the following code(s) are appropriate: Z34.-......
Hi are you able to send me the link to this document or the location within ACOG website where I can find it? I need to appeal to payer but wanted an official document from ACOG. Thanks in advance
 
What would you do if patient comes in for vaginal itching and just simply tells the dr she is pregnant, my physician does not do a urine test or bhcg test to confirm but still addressed not only the vaginal itching but also the n/v she complains of? They coded N89.8, N94.9 and O21.9 and the insurance is denying it for bundling to the OB package. This patient also came to one OB office for this visit but established care with a different OB practice for her antepartum care. I am leaning towards appealing but just not sure that is enough. Running into this quite a bit for visits that occur prior to the true initial OB visit.
 
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