Question yeast infection during pregnancy

rleif1sun

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if during routine prenatal visit patient C/O vaginal itching. VE: + Yeast infection. RX: Terconazole and Diflucan.
is this considered outside of prenatal care and gets e/m to bill?
 

rleif1sun

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Yes, you can bill for nonobstetrical conditions during the antepartum period.
im just confused what is considered non obstetrical since its common in pregnancy to develop these symptoms. for exp. pt complains of vaginal itching during her routine visit. rapid BV test was positive and was prescribed medication.
 

Cmama12

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I pulled this from UHC Community policy because it mentions UTIs as being unrelated, which is a similar condition. Just to give a general idea..

B. Services Excluded from the Global OB Package
Per CPT guidelines and ACOG, the following services are excluded from the global OB package (CPT codes 59400, 59510, 59610, 59618) and may be reported separately if warranted:
• First three antepartum E&M visits
• Laboratory tests • Maternal or fetal echography procedures (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, 76821, 76825, 76826, 76827 and 76828). For additional information, see E/M Service with an OB Ultrasound Procedure section.
• Amniocentesis, any method • Amnioinfusion • Chorionic villus sampling (CVS) • Fetal contraction stress test • Fetal non-stress test • External cephalic version • Insertion of cervical dilator more than 24 hours before delivery
• E/M services for management of conditions unrelated to the pregnancy (e.g., bronchitis, asthma, urinary tract infection) during antepartum or postpartum care; the diagnosis should support these services. For further information, please refer to the Non OB Care section of this policy.
• Additional E/M visits for complications or high risk monitoring resulting in greater than the typical 13 antepartum visits; per ACOG these E/M services should not be reported until after the patient delivers. Append modifier 25 to identify these visits as separately identifiable from routine antepartum visits
 

natashalage

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... in addition to the above response, there is a very good article on AAPC called 'Correct Common OB/GYN Coding mistakes" June 10,2019. I personally cut it out from the magazine and keep it in my folder. It describes some examples what you can code as E/M outside of global. I am a new coder but in my mind i also try to remember if MD prescribed the medication, to me it's E/M that separately reportable. The article says " Services rendered during the global period of another service are often overlooked... Problems not related to preg. such as yeast infections, vaginitis, and sexually trans. disease are not part of the global delivery package." Here is one example from this article.

Example 1​

A patient comes in for her routine prenatal visit and complains of a vaginal discharge with odor. The physician performs an exam, collects cultures for a wet prep, and discovers acute vaginitis. The provider educates the patient on bacterial vaginosis and treats it with clindamycin. The additional codes to assign on this claim, outside of prenatal codes, are:
CPT®: 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity and 87210 Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps); or, for some payers (including Peachstate Health Plan, Aetna, Medicaid, and Amerigroup), HCPCS Level II Q0111 Wet mounts, including preparations of vaginal, cervical or skin specimens (rather than 87210) for the wet prep.
ICD-10: N76.0 Acute vaginitis
The provider should document the details of the visit on the encounter note. If you see a patient was diagnosed and treated for problems outside of global delivery but do not see an evaluation and management (E/M) service level billed, query the provider.
 
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