# Late prenatal care and the OB package



## Scruz09 (Oct 29, 2015)

Hello!

We had a new patient coming into our office for late prenatal care. She is 18 weeks and has not seen a physician. She had a UPT come back positive 18 weeks ago. 

We cant really "confirm" someone pregnant at 18 weeks. And since there was no prenatal care yet, it had to be started immediately since it was so late in the pregnancy. 

So when I billed the charges, I dropped an OBNC and the ultrasound. Well, the MD believes that we can bill both an E/M and the Ultrasound since we did a whole work up on her since she's a new patient. 

What is your opinion of this? I feel like the visit would be considered part of the global...right?

http://www.acog.org/About-ACOG/ACOG-Departments/Coding/Reporting-the-Confirmation-of-Pregnancy-Visit


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## sugar40 (Oct 29, 2015)

What did the Unltrasound show? And why you can't confirm a pregnancy at 18 week? Pregnancy trimester goes from 0-12 weeks, 12-24 weeks and 24-36 wewks. Code Z3A.18.


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## CodingKing (Oct 29, 2015)

I see a few payers payment policies where it states to bill global if there are 4 or more antepartum visits, delivery and postpartum care performed by the group. You may want to check with the patients insurance to see if they want it broken out or not.


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## valleyobgynut (Nov 4, 2015)

If the patient has not been seen by another office you can bill global. Assuming she stays for the remainder of her pregnancy. Once you start the prenatal flow sheet this visit would be considered part of the global package. You can bill for the u/s but not for the visit. Yes, you are right in how you billed. I would have done the same.


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## Cmama12 (Nov 12, 2015)

It depends if the flowsheet was started or not.  Sometimes they come in to confirm the pregnancy but it's not their official first OB visit.. those are usually billed with E/Ms.


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## Annmarie4412 (Nov 16, 2015)

Is the patient presenting with any other complaints? Was the flowsheet started? What counseling did the provider do? Was everything normal? What diagnosis was used? I am thinking that this falls under the global package. I would bill for an E/M IF there was a complaint and if it was seperate from the pregnancy.


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## Billing2012 (Dec 10, 2015)

*I refere to coding books*

According with CPT coding book by AMA , you can only bill an EM code if you dx the pregnancy. Since she came with 18 weeks of pregnancy and not for another problem; the first visit falls into the global.


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