Ob/gyn help

Messages
110
Best answers
0
Hi everyone...I just started billing for an ob/gyn and also a maternal fetal medicine and I am very confused. Any suggestions???

Thanks!!!
 
Messages
110
Best answers
0
I'm confused on the ultrasounds and modifers that should be attached. When I look up the definition and read the Dr. notes it's confusing. Example, my Dr codes 76811, 76817, 76819 and 76820. Some are not covered by insurances, when I read the definition of the procedure, I'm not even sure it's right to bill it out. Thanks for any help you can give me.
 

Chelle-Lynn

True Blue
Messages
729
Location
Modesto, CA
Best answers
0
76811 - Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation

Code 76811 is used for an obstetric ultrasound with detailed fetal anatomic evaluation of a single gestation or the first gestation in a multiple pregnancy. The mother presents with a full bladder. Acoustic coupling gel is applied to the skin of the lower abdomen. The transducer is pressed firmly against the skin and swept back and forth over the lower abdomen and images obtained of the pregnant uterus, surrounding pelvic structures, and fetus. The ultrasonic wave pulses directed at the fetus, pregnant uterus, and surrounding pelvic structures of the mother are imaged by recording the ultrasound echoes. Any abnormalities are evaluated. The physician reviews the ultrasound images of the fetus, pregnant uterus, and maternal pelvic structures, and provides a written interpretation.


76817 - Ultrasound, pregnant uterus, real time with image documentation, transvaginal


The patient is first asked to empty the bladder. A protective cover is placed over the transducer and acoustic coupling gel is applied to the cover. The transducer is inserted into the vagina and images of the fetus, pregnant uterus, and maternal structures are obtained from different orientations. Any abnormalities are evaluated. The physician reviews the images and provides a written interpretation.

76819 - Fetal biophysical profile; without non-stress testing

The mother presents with a full bladder. Acoustic coupling gel is applied to the skin of the lower abdomen. The transducer is pressed against the skin and swept back and forth over the lower abdomen and general exam performed to identify the location of the fetus and the presence of cardiac activity. Placental position may also be noted. Following the general exam, amniotic fluid volume is assessed, gross fetal motion and tone are evaluated, and breathing movements are evaluated. A non-stress test (NST) may also be performed using a fetal monitor. NST typically requires a minimum of 30 minutes of fetal monitoring. A biophysical score (BPS) is calculated and the risk of fetal asphyxia and fetal death determined. The physician reviews the ultrasound images, reads the NST, determines the BPS, and provides a written interpretation.

76820 - Doppler velocimetry, fetal; umbilical artery

The mother is positioned in a semi-recumbant position with a slight lateral tilt to minimize the risk of supine hypotension syndrome. Acoustic coupling gel is applied to the skin of the lower abdomen and the transducer pressed against the lower abdomen. The transducer is manipulated to obtain Doppler frequency shift waveforms from the umbilical artery. Continuous wave or pulsed wave Doppler interrogation is then used to assess umbilical artery blood flow by evaluating downstream impedance. The Doppler waveforms are displayed on a video monitor. The screen is frozen when appropriate signals are displayed, and measurements are performed. These measurements are then used to calculate indices that characterize downstream impedance. The indices used include umbilical artery systolic-diastolic (S/D) ratio, resistance index (RI), or pulsatility index (PI). The physician reviews the ultrasound imaging, calculates indices, evaluates umbilical artery blood flow velocity, and provides a written report.



I have provided a detail of what is contained in each of the radiology procedures noted above. Since there are multiple modifiers that can be used, it you can specify which ones you are specifically confused on, it will help to narrow down your question.
 

Chelle-Lynn

True Blue
Messages
729
Location
Modesto, CA
Best answers
0
Then probably not. See below for inclusions to the global billing to help make your decision:

59400: Routine OB including antepartum, vaginal delivery, and postpartum care
59510: Routine OB including antepartum, cesarean-section (C-section), and postpartum
59610: Routine OB including antepartum, vaginal birth after C-section (VBAC), and postpartum

These package codes cover the first visit through the six-week postpartum period. Providers should bill them as a one-time procedure after delivery.

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)

Delivery services normally include:
◾Admission to the hospital
◾Admission history and examination
◾Supervision or management of uncomplicated labor, including induction services
◾Vaginal, C-section or VBAC delivery
◾Delivery of placenta
◾Episiotomy
◾Initial evaluation and resuscitation of the newborn by the obstetrician
◾Fetal scalp blood sampling and application of fetal scalp electrodes and electronic fetal monitoring
◾Physician standby services

Postpartum services normally include:
◾Outpatient office visits for six weeks.
◾Inpatient hospital admission directly related to the pregnancy for a period of six weeks. Note: This follow-up time frame is for vaginal and C-section services. This differs from the customary zero, 10, 90 global time followed for surgical procedures.

CPT has some general coding rules that coders should follow closely when using a package code (i.e., 59400, 59410, and 59610) CPT does not specify that a physician must provide a certain number of visits to use the global OB package. Physicians commonly see patient for approximately 13 antepartum visits; however, that is not always the case. The following visit schedules are also used:
◾One visit every four to five weeks up to 28 weeks
◾One visit every two weeks up to 36 weeks
◾One visit every week from 36 weeks until delivery

Providers should not bill separately for services bundled as part of the routine OB care visits. The following are part of the routine OB visit:
◾Pap smear at first prenatal visit. Note: This applies only to the Pap smear procedure. The laboratory processing is separately identifiable and payable.
◾Routine Urine Dip provided in-office (code 81002).
◾Education on breast feeding, lactation and pregnancy (HCPCS level II codes S9436–S9438, S9442–S9443)
◾Exercise consultation or nutrition counseling during pregnancy (HCPCS level II codes S9449–S9452, S9470
 

Chelle-Lynn

True Blue
Messages
729
Location
Modesto, CA
Best answers
0
If your provider is only doing an ultra-sound and not an evaluation and management, then no. Again it depends on the services rendered and the documentation and the global billing parameters, number of visits, etc.
 

Cmama12

Guru
Messages
144
Best answers
1
If the patient is seeing an MFM provider, then you can bill OV for the part over and beyond regular antenatal care that they are seeing MFM for and global for regular antenatal care.
 

jrhinelander

New
Local Chapter Officer
Messages
7
Location
Savannah, GA
Best answers
0
Question about ICD 10 codes: O42

This may be a silly question, but I am fairly new to OB coding, and sometimes I wonder about code usage with deliveries. Specifically these two codes:

O42.013
Preterm premature rupture of membranes, onset of labor within 24 hours of rupture, third trimester
O42.02
Full-term premature rupture of membranes, onset of labor within 24 hours of rupture

Is there an actual week that separates preterm from Full-term? Also, if the Full-term one is actual full term as in 39 weeks, why would it still be a "premature rupture"?

Thank you,
Joe
 

Palmtoptiger

Guest
Messages
17
Location
Makati Philippines
Best answers
0
Hi,

Pre term = before 37 completed weeks of gestation
Full term = after 37 completed weeks of gestation

Premature rupture of membrane could happen even at full term if the amniotic sac breaks and the labor has not yet started.


Thanks,
 
Last edited:

lminneti

Contributor
Messages
17
Location
Valley City , ND
Best answers
0
gyn question

hi all
I have question on coding. pt comes in to ob dr and has her annual exam done. in the dr note he states visit type as annual exam but for the dx he states encounter for routine gyn exam w/pap of cervix plus vaginal pap smear. how would this be coded so that the insurance pays it? :confused::confused:

Thanks
 

jrhinelander

New
Local Chapter Officer
Messages
7
Location
Savannah, GA
Best answers
0
Reference / Publication?

What publication is that from? I have been coding OB/GYN for about 8 months now, and am always looking for new reference material. (On a side note, I have found that the COBGC Study Guide can be very useful) Thanks!
Then probably not. See below for inclusions to the global billing to help make your decision:

59400: Routine OB including antepartum, vaginal delivery, and postpartum care
59510: Routine OB including antepartum, cesarean-section (C-section), and postpartum
59610: Routine OB including antepartum, vaginal birth after C-section (VBAC), and postpartum

These package codes cover the first visit through the six-week postpartum period. Providers should bill them as a one-time procedure after delivery.

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)

Delivery services normally include:
◾Admission to the hospital
◾Admission history and examination
◾Supervision or management of uncomplicated labor, including induction services
◾Vaginal, C-section or VBAC delivery
◾Delivery of placenta
◾Episiotomy
◾Initial evaluation and resuscitation of the newborn by the obstetrician
◾Fetal scalp blood sampling and application of fetal scalp electrodes and electronic fetal monitoring
◾Physician standby services

Postpartum services normally include:
◾Outpatient office visits for six weeks.
◾Inpatient hospital admission directly related to the pregnancy for a period of six weeks. Note: This follow-up time frame is for vaginal and C-section services. This differs from the customary zero, 10, 90 global time followed for surgical procedures.

CPT has some general coding rules that coders should follow closely when using a package code (i.e., 59400, 59410, and 59610) CPT does not specify that a physician must provide a certain number of visits to use the global OB package. Physicians commonly see patient for approximately 13 antepartum visits; however, that is not always the case. The following visit schedules are also used:
◾One visit every four to five weeks up to 28 weeks
◾One visit every two weeks up to 36 weeks
◾One visit every week from 36 weeks until delivery

Providers should not bill separately for services bundled as part of the routine OB care visits. The following are part of the routine OB visit:
◾Pap smear at first prenatal visit. Note: This applies only to the Pap smear procedure. The laboratory processing is separately identifiable and payable.
◾Routine Urine Dip provided in-office (code 81002).
◾Education on breast feeding, lactation and pregnancy (HCPCS level II codes S9436–S9438, S9442–S9443)
◾Exercise consultation or nutrition counseling during pregnancy (HCPCS level II codes S9449–S9452, S9470
 

jdibble

True Blue
Messages
786
Location
Daytona Beach, FL
Best answers
0
hi all
I have question on coding. pt comes in to ob dr and has her annual exam done. in the dr note he states visit type as annual exam but for the dx he states encounter for routine gyn exam w/pap of cervix plus vaginal pap smear. how would this be coded so that the insurance pays it? :confused::confused:

Thanks

A patient coming to an OB doctor for an annual exam is for a routine GYN exam. For the above diagnoses you would use Z01.419 - Encounter for gynecological examination without abnormal findings (this includes the cervical pap) and then Z12.72 for the vaginal pap. You would use the appropriate well exam E/M code based on whether the patient is new or established and the patient's age.
 

DeniseD

New
Messages
3
Best answers
0
very good info about routine OB

the response was very informative. Can someone tell me where this came from? Was it from ACOG? thank you

Denise
 
Top