Wiki E/M vs Initial OB

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KoBee

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Can someone help me understand the difference or can you share any coding resources. Just want to make sure if a provider can bill a separate E/M for confirmation of pregnancy or considered to be initial OB. Patient saw her PCP via telemedicine prior who diagnosed Amenorrhea with positive home pregnancy test and referred to follow up with OB. To continue with prenatal vitamins.

But PCP didn't order a test to confirm pregnancy besides the patient doing a home test. Just the referral to OB. I want to make sure the OB provider can bill an E/M and not considered this visit the initial OB. I have read where it states if OB started the prenatal record then this would be considered the initial OB, how would I know that?



here is the visit:

31 y.o.-year-old　female　presents for confirmation of pregnancy. She has irregular menses. LNMP was on 1/3/21?　Denies hematuria or hematochezia. Denies bowel and bladder changes.

Ob/gyn hx: G1

Physical exam:
The patient declines nurse presence for examination

Blood pressure 143/82, pulse 118, height 5' 2" (1.575 m), weight 156 lb (70.8 kg), last menstrual period 01/03/2021.


General: alert and oriented and in no acute distress

Abdomen: soft nontender to palpation, positive bowel sounds. No hernia

Pelvic Exam:
Deferred
PSYCHIATRIC: alert and oriented to time, place and person
UCG+

Obstetrical Ultrasound:
Single IUP with　AUA　consistent with 6-7　weeks. Positive cardiac motion. Measurements sub-optimal on abdominal scan, she declines vaginal scan

Assessment:
1. Amenorrhea:
Prenatal Profile I, UA/M w/rflx Culture, Routine, HIV 1/0/2 Antigen/AB 4th Generation

2. early pregnancy at 6-7 weeks


PLAN:
Prenatal lab panel, PAP and genital cultures​
Start prenatal vitamins

I spent　30　minutes reviewing the patient's diagnostic tests, labs, examining the patient, counseling the patient, reviewing the treatment options/plan and documenting in the medical record.
 
KoBee said:
Can someone help me understand the difference or can you share any coding resources. Just want to make sure if a provider can bill a separate E/M for confirmation of pregnancy or considered to be initial OB. Patient saw her PCP via telemedicine prior who diagnosed Amenorrhea with positive home pregnancy test and referred to follow up with OB. To continue with prenatal vitamins.

But PCP didn't order a test to confirm pregnancy besides the patient doing a home test. Just the referral to OB. I want to make sure the OB provider can bill an E/M and not considered this visit the initial OB. I have read where it states if OB started the prenatal record then this would be considered the initial OB, how would I know that?



here is the visit:

31 y.o.-year-old　female　presents for confirmation of pregnancy. She has irregular menses. LNMP was on 1/3/21?　Denies hematuria or hematochezia. Denies bowel and bladder changes.

Ob/gyn hx: G1

Physical exam:
The patient declines nurse presence for examination

Blood pressure 143/82, pulse 118, height 5' 2" (1.575 m), weight 156 lb (70.8 kg), last menstrual period 01/03/2021.


General: alert and oriented and in no acute distress

Abdomen: soft nontender to palpation, positive bowel sounds. No hernia

Pelvic Exam:
Deferred
PSYCHIATRIC: alert and oriented to time, place and person
UCG+

Obstetrical Ultrasound:
Single IUP with　AUA　consistent with 6-7　weeks. Positive cardiac motion. Measurements sub-optimal on abdominal scan, she declines vaginal scan

Assessment:
1. Amenorrhea:
Prenatal Profile I, UA/M w/rflx Culture, Routine, HIV 1/0/2 Antigen/AB 4th Generation

2. early pregnancy at 6-7 weeks


PLAN:
Prenatal lab panel, PAP and genital cultures​
Start prenatal vitamins

I spent　30　minutes reviewing the patient's diagnostic tests, labs, examining the patient, counseling the patient, reviewing the treatment options/plan and documenting in the medical record.
Click to expand...
In my opinion, this physician is evaluating the pregnancy, not simply confirming she is pregnant, because he did an ultrasound to evaluate the fetus, and also because she was counseled regarding treatment options which would of course be related to pregnancy care even though the exact content of the conversation is not documented. The basic confirmation of pregnancy visit is a low level visit with a UA pregnancy test and then you can order labs, but stop there.
 
I agree with the above. PCP basically took the patients word for being pregnant without confirming. With only a referral to an OB provider I would bill the E/M, and UA pregnancy test and then begin the ob flow sheet on the return visit.
 
This document is older (link is no longer valid) but should provide some guidance-


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.

Questions/comments may be sent to ACOG's Coding Staff by registering at https://acogcoding.freshdesk.com

http://www.acog.org/About-ACOG/ACOG-Departments/Coding/Reporting-the-Confirmation-of-Pregnancy-Visit
 
Hi all,
If patient presents for missed period and UA pregnancy test in clinic returns positive would you report Z32.01 and Z3A.00 for the E/M?
Not N92.5 for missed period as this is a related sign/symptom of the confirmed diagnosis?
TIA
 
mcdream said:
Hi all,
If patient presents for missed period and UA pregnancy test in clinic returns positive would you report Z32.01 and Z3A.00 for the E/M?
Not N92.5 for missed period as this is a related sign/symptom of the confirmed diagnosis?
TIA
Click to expand...
You code what you know at the end of the visit. Since at the end of this visit you know she is pregnant, you would report the code for a positive pregnancy test )Z32.01. You would not report Z3a.00 as this code is only required with the OB Chapter "O" codes.
 
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