Wiki Initial ob visit

TYSON1234

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Good afternoon, just looking for some clarification. My Dr. does her own new ob intake appointments. She seems to think that this visit should be billable because she spends atleast 45 minutes with the patient. I know awhile back, somebody posted some information from ACOG regarding this initial visit and I can't find it. I have argued with the her time and time again that it isn't billable because she started the ob chart and she confirmed the pregnancy with a urine test. If somebody could please send me the information so I can show it to her. Also, if there has been a change in the billing for this and it is now billable, could somebody let me know.

Thank you😀
 
What I've found is if the patient comes in on a separate date to confirm the pregnancy, that visit is separately billable. The initial OB visit starts the episode and is included in the global package. Some payers will cover the initial OB visit separately. You'll have to look into the individual payer policies to know which ones do. Most times if they have already paid on the initial visit when the global package bills, they recoup the payment for the initial visit and bundle it into the package. For that reason my hospital includes it in the global package for all payers. I went onto ACOG and couldn't find anything on the services included in the full global. I could only find what's included in the postpartum period. I was able to find the information below from a different website though.

The following antepartum services are normally included in the package.
  • First prenatal visit or initial evaluation, including a history and physical (H&P) exam
  • Pregnancy evaluation and progress screening (i.e., subsequent or interval H&P exams, recording of weight, blood pressure, specimen handling, and routine automated chemical urinalysis)
  • Care of complications during the gestational period specific to obstetrical care or that constitute the management of a chronic, stable illness (e.g., pre-eclampsia, premature labor, diabetes, epilepsy, lupus erythematous or hypertension)
 
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.-......
 
What I've found is if the patient comes in on a separate date to confirm the pregnancy, that visit is separately billable. The initial OB visit starts the episode and is included in the global package. Some payers will cover the initial OB visit separately. You'll have to look into the individual payer policies to know which ones do. Most times if they have already paid on the initial visit when the global package bills, they recoup the payment for the initial visit and bundle it into the package. For that reason my hospital includes it in the global package for all payers. I went onto ACOG and couldn't find anything on the services included in the full global. I could only find what's included in the postpartum period. I was able to find the information below from a different website though.

The following antepartum services are normally included in the package.
  • First prenatal visit or initial evaluation, including a history and physical (H&P) exam
  • Pregnancy evaluation and progress screening (i.e., subsequent or interval H&P exams, recording of weight, blood pressure, specimen handling, and routine automated chemical urinalysis)
  • Care of complications during the gestational period specific to obstetrical care or that constitute the management of a chronic, stable illness (e.g., pre-eclampsia, premature labor, diabetes, epilepsy, lupus erythematous or hypertension)
Thank you for the information.
 
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 for the information. Do you have the link by chance?
 
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