Confirmation of pregnancy E/M

natashalage

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Hello, I posted this question to the existing 2009 thread in this forum but somehow my question did not appear as a current topic for the discussion? do you know if I can pull out the old thread and make it current?
here’s my question and I will greatly appreciate your help. What prim dx should i use when pt comes for verification of pregnancy? it's not a part of global and we know it's payable. So, pt comes to the office, ultrasound is done, pregnancy is confirmed, we also might have a positive urine test = Z32.01- Encounter for pregnancy test, result positive.
The reason for the visit MD puts- Amenorrhea. Then MD adds dx in A/P: Anxiety, IVF etc. (O-codes since pt is pregnant). I know that for 76815 US I use Z32.01. But what is the order of dx for E/M visit? Per coding guidelines, O-code are listed first, so i cannot put prim dx : Z32.01 nor Amenorrhea. Then, I think, for insurance this E/M will look like OB global visit and i am afraid they might not pay for it. So, how can i tell the insurance that this visit is for confirmation of pregnancy? O-codes first and then z32.01?
Thank you very much for your rational.
 

Anastasia

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This isn't an OB visit so you shouldn't use an O code, otherwise the insurance will consider this an OB visit and include it with antepartum care. Use Z32.01 for the E/M and the US because this is a Gyn visit per ACOG.
 

Cmama12

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Whether or not it is an OB visit depends on whether they started the OB flow chart at that visit. If not, then you can bill E/M with the positive preg test dx - you still might not get paid for it though. Here is an old document from ACOG on the subject:

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.

Note that some payers may now view an initial obstetrical ultrasound performed in the office at the initial visit, as part of the comprehensive work up that initiates the global package. If this service is performed, your specific payer may view the initial visit as included in the global OB package even if the visit is reported with an E/M service code.

Not all payers follow CPT guidelines as to the contents of the global obstetrics package. You should always check with your specific payers for their definition of the global obstetrics package. Be sure to keep a written copy of any instructions.

A final point to keep in mind is that not every initial OB visit will be reportable outside of the global package. Deciding when to initiate the global OB care depends on the clinical circumstances, the physicians’ medical judgment, and payer reimbursement policies.
 
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Whether or not it is an OB visit depends on whether they started the OB flow chart at that visit. If not, then you can bill E/M with the positive preg test dx - you still might not get paid for it though. Here is an old document from ACOG on the subject:

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.

Note that some payers may now view an initial obstetrical ultrasound performed in the office at the initial visit, as part of the comprehensive work up that initiates the global package. If this service is performed, your specific payer may view the initial visit as included in the global OB package even if the visit is reported with an E/M service code.

Not all payers follow CPT guidelines as to the contents of the global obstetrics package. You should always check with your specific payers for their definition of the global obstetrics package. Be sure to keep a written copy of any instructions.

A final point to keep in mind is that not every initial OB visit will be reportable outside of the global package. Deciding when to initiate the global OB care depends on the clinical circumstances, the physicians’ medical judgment, and payer reimbursement policies.
is there another document/article that has the above info?? I used to have that article but it is no longer posted on ACOG and i need something to show the comprehensive H&P is part of the global care...???? anything will help!! thank you in advance! :)
 
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