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Thread: Two Questions

  1. #1
    Join Date
    Apr 2007

    Default Two Questions

    AAPC: Back to School
    Problem vs Routine Care in Pregnancy: If a patient with EGA 35-39 weeks presents to the office c/o back pain or edema or pelvic pressure, etc (symptoms only and not part of a more serious condition) are those visits considered problem vists or routine? My opinion is that a problem visit would if the patient were ill, has vaginitis, UTI, etc, something not related to her pregnancy, and that other general symptoms are part of being pregnant and covered under her ROB. Is this wrong?

    Late Transfer of Care: We had a patient who transferred to our practice at 30 weeks. She had been receiving PNC but recently moved to the area. Theoretically, she would be seen anywhere from 6-9 times in our office, then we would deliver her and provide PP. The doctor wants to bill antepartum care, the delivery, and the PP visit all separately, but I think that we could still potentially bill the global code, maybe with a -52 modifier reduced services because of her EGA. What is the correct way to bill this?

  2. #2


    In answer to the first question in our office the symptoms you described ie
    back pain, pelvic pressure,edema as related to the pregnancy. However any-
    thing like URI, a cold, unrelated symptoms are problem visits and can be billed as an office visit.

    We have received a number of late transfer's and have billed both ways.
    Antepartum care, and Delivery separately however I have billed the delivery
    code with postpartum care if the patient will continue to stay with us.
    I have also billed as global with the modifier 52 and got paid. It realy depends on the payor.

    I hope this helps.
    Dee R.

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    As far as a dx goes If you read in the guidelines it states to use 648.xx for pat with current conditions affecting the management of the pregnancy, it goes further and states it is the providers responsibility to state that the current condition is NOT affecting the management of the pregnancy. So even with the sinusitis dx the 648.xx would be the first listed dx with the sinusitis secondary, unless he states the sinusitis is not affecting the management of the pregnancy

    Debra A. Mitchell, MSPH, CPC-H

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