confirm pregnancy billing

Naira

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Hi,
I would like to know how to bill OBGYN claims if the patient come to the OB office and doctor confirm pregnancy it is 8 and up weeks and doctor opens a flow sheet. Should it be coded an E&M level or global period code?
 

ndanh01

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Federal Way, WA
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An initial visit, confirming the pregnancy, is not a part of global maternity care services. You can bill the initial visit with an E/M code using a dx of V72.4x. This can only be billed if the OB record has not yet been started, the main purpose of this visit is to confirm the pregnancy only. If the OB record has been started you cannot bill this visit out separately, it will be considered part of the global maternity care package.
 

lipearso

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pregnancy confirmation

If a patient is scheduled to see an OB physician for the first time, and brings with her a home pregnancy test or documentation from her PCP confirming a positive pregnancy test, is the first visit coded as an E/M or as part of the global?
 

hollyw42

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Gaithersburg, MD
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Depends on what the visit was for and how it was documented. The initial E/M is outside global care if the visit is to diagnose the pregnancy AND the prenatal record is not initiated at the encounter. If the prenatal record was not initiated than yes you can bill the service separately.

We never bill the 'confirmation' visit separate as we always initiate the prenatal record at the 'confirmation' visit.

You would need to use diagnosis code Z32.01 on your claim.
 

markel918

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Arlington, WA
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In most cases if someone else like a pcp or another clinic confirmed pregnancy then no you can not bill an e&m confirming the pregnancy. We bill an e&m with Z32.01 to confirm our patients pregnancy (if someone else hasn't already) and then they will come back if everything is looking normal and start their global care at the next visit and start the flow sheet.
 
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Depends on what the visit was for and how it was documented. The initial E/M is outside global care if the visit is to diagnose the pregnancy AND the prenatal record is not initiated at the encounter. If the prenatal record was not initiated than yes you can bill the service separately.

We never bill the 'confirmation' visit separate as we always initiate the prenatal record at the 'confirmation' visit.

You would need to use diagnosis code Z32.01 on your claim.
Do you have any guidelines you use from ACOG regarding what is considered opening the Global care package? I'm attempting to start this discussion with my providers and I know ACOG had some information about this before but I can't seem to find it.

Thank you!
 

maparso96

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This is an old document from ACOG. Not sure if this is what you're looking for.

Reporting the Confirmation of Pregnancy Visit
ACOG often receives questions from Fellows as to whether the initial visit to confirm a pregnancy may be reported as an E/M visit separately from the global OB package.
The initial OB visit may be reported as an E/M service under certain conditions. Even if the patient has taken a home pregnancy test, the initial visit may still be billed as an E/M service as you will be officially confirming the pregnancy.
When coding for the “initial ob visit”, there are a few things that have to be taken into consideration. First you have to determine if the patient is there for a confirmation of pregnancy or if the pregnancy has already been confirmed. The second thing that needs to be determined is if the OB record has been initiated. Once this has been established you can determine how the visit should be reported.
Here is an example to help clarify the issue:
If a patient presents with signs or symptoms of pregnancy or has had a positive home pregnancy test and is there to confirm pregnancy, this visit may be reported with the appropriate level E/M services code. However, if the OB record is initiated at this visit, then the visit becomes part of the global OB package and is not billed separately.
If the pregnancy has been confirmed by another physician, you would not bill a confirmation of pregnancy visit.
The confirmation of pregnancy visit is typically a minimal visit that may not involve face to face contact with the physician (for an established patient). The physician may draw blood and prescribe prenatal vitamins during this initial visit and still report it as a separate E/M service as long as the OB record is not started.
Diagnostic Reporting Options:
V72.40 Pregnancy examination or test, pregnancy unconfirmed
V72.41 Pregnancy examination or test, negative result
V72.42 Pregnancy examination or test, positive result
The physician should report V72.40 if the encounter is to test for a suspected pregnancy and the patient leaves without knowing the results. If the pregnancy test is negative, report code V72.41. Report code V72.42 if the pregnancy is confirmed but the obstetrical record is not initiated. This diagnosis code is also used when the physician sees the patient for the confirmation of pregnancy but will not be providing the global obstetric care.
Global obstetrical care begins when antepartum services are provided, or the obstetrical record is initiated as part of the physician's comprehensive obstetrics work-up which includes the comprehensive history and physical.
 

MKESSINGER

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If the patient has an ultrasound to confirm pregnancy and how far along they are and the doctor goes over the ultrasound report and talks to the patient over the "do and don'ts" during their pregnancy, can you charge an E/M visit and use Z32.01 for the diagnosis code?
 
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