Wiki First prenatal visit and pap

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jpsimons78

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When initiating our global ob package beginning with the first prenatal visit, our physician does a complete workup including a pap smear. We have always billed the pap as included in the global package; however, the patient may receive a bill from the lab. If a patient is due for their annual pap and exam, can this be billed in addition to the first prenatal visit, in which there is no charge? I have always understood the exam and pap were included. Any clarification would be appreciated. Thank you.
 
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You are correct - the pap and the exam are included in the first antenatal visit - the patient is not being provided with an annual well woman exam, they are being provided with an initial obstetrics evaluation, of which a pap is a recommended part. ACOG guidelines via UHC:

First Prenatal Visit (8-10 weeks of pregnancy if first contact earlier)
Assessment • Initial history and physical. • Family medical history. • Genetic history. • General exam to confirm pregnancy. • Complete needs assessment. • Preterm labor risk, education and prevention. • Assess for tobacco, alcohol, drug use. • Domestic violence screening. • Prescriptions: prenatal vitamins and iron supplementation as necessary.
Education and counseling • Scope of care provided in the office and anticipated schedule of visits. • Advise regarding specific complications. • Discuss lab studies/testing; expected course of pregnancy; genetic counseling and testing including Cystic Fibrosis (CF) and tests for aneuploidy; HIV counseling/education; breastfeeding, choosing the child’s physician • Education regarding: Labor and delivery, nutrition, exercise, working, air travel, routine dental care, tobacco use and smoke exposure, alcohol/drug consumption, etc. • Practices to promote health maintenance such as use of safety restraints including lap and shoulder belts • Encourage prenatal classes • Encourage maternity program enrollment • Offer influenza vaccination, regardless of the stage of pregnancy, if the woman will be pregnant during the influenza season.
Laboratory/diagnostic studies • Type and screen • CBC for H&H and MCV • Hepatitis B surface antigen (HBsAg) • RPR • Chlamydia if ≤ age 25 or >25 with risk factors2 • Screening for gestational diabetes if at high risk (see section on gestational diabetes below) • HIV testing unless they decline (opt-out approach) • Pap smear (if not done pre-pregnancy) • Urinalysis including microscopic examination • Urine C&S • Any additional testing indicated by the risk assessment or genetic history
 
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katrinak said:
You are correct - the pap and the exam are included in the first antenatal visit - the patient is not being provided with an annual well woman exam, they are being provided with an initial obstetrics evaluation, of which a pap is a recommended part. ACOG guidelines via UHC:

First Prenatal Visit (8-10 weeks of pregnancy if first contact earlier)
Assessment • Initial history and physical. • Family medical history. • Genetic history. • General exam to confirm pregnancy. • Complete needs assessment. • Preterm labor risk, education and prevention. • Assess for tobacco, alcohol, drug use. • Domestic violence screening. • Prescriptions: prenatal vitamins and iron supplementation as necessary.
Education and counseling • Scope of care provided in the office and anticipated schedule of visits. • Advise regarding specific complications. • Discuss lab studies/testing; expected course of pregnancy; genetic counseling and testing including Cystic Fibrosis (CF) and tests for aneuploidy; HIV counseling/education; breastfeeding, choosing the child’s physician • Education regarding: Labor and delivery, nutrition, exercise, working, air travel, routine dental care, tobacco use and smoke exposure, alcohol/drug consumption, etc. • Practices to promote health maintenance such as use of safety restraints including lap and shoulder belts • Encourage prenatal classes • Encourage maternity program enrollment • Offer influenza vaccination, regardless of the stage of pregnancy, if the woman will be pregnant during the influenza season.
Laboratory/diagnostic studies • Type and screen • CBC for H&H and MCV • Hepatitis B surface antigen (HBsAg) • RPR • Chlamydia if ≤ age 25 or >25 with risk factors2 • Screening for gestational diabetes if at high risk (see section on gestational diabetes below) • HIV testing unless they decline (opt-out approach) • Pap smear (if not done pre-pregnancy) • Urinalysis including microscopic examination • Urine C&S • Any additional testing indicated by the risk assessment or genetic history
Click to expand...
katrinak said:
You are correct - the pap and the exam are included in the first antenatal visit - the patient is not being provided with an annual well woman exam, they are being provided with an initial obstetrics evaluation, of which a pap is a recommended part. ACOG guidelines via UHC:

First Prenatal Visit (8-10 weeks of pregnancy if first contact earlier)
Assessment • Initial history and physical. • Family medical history. • Genetic history. • General exam to confirm pregnancy. • Complete needs assessment. • Preterm labor risk, education and prevention. • Assess for tobacco, alcohol, drug use. • Domestic violence screening. • Prescriptions: prenatal vitamins and iron supplementation as necessary.
Education and counseling • Scope of care provided in the office and anticipated schedule of visits. • Advise regarding specific complications. • Discuss lab studies/testing; expected course of pregnancy; genetic counseling and testing including Cystic Fibrosis (CF) and tests for aneuploidy; HIV counseling/education; breastfeeding, choosing the child’s physician • Education regarding: Labor and delivery, nutrition, exercise, working, air travel, routine dental care, tobacco use and smoke exposure, alcohol/drug consumption, etc. • Practices to promote health maintenance such as use of safety restraints including lap and shoulder belts • Encourage prenatal classes • Encourage maternity program enrollment • Offer influenza vaccination, regardless of the stage of pregnancy, if the woman will be pregnant during the influenza season.
Laboratory/diagnostic studies • Type and screen • CBC for H&H and MCV • Hepatitis B surface antigen (HBsAg) • RPR • Chlamydia if ≤ age 25 or >25 with risk factors2 • Screening for gestational diabetes if at high risk (see section on gestational diabetes below) • HIV testing unless they decline (opt-out approach) • Pap smear (if not done pre-pregnancy) • Urinalysis including microscopic examination • Urine C&S • Any additional testing indicated by the risk assessment or genetic history
Click to expand...

Thank you so much for your help and clarification! Jennifer
 
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