# What is the correct way to bill an initial OB visit?



## jdibble (Dec 3, 2012)

This whole initial visit thing has me confused on how my doctors should bill the initial visit - can anyone give a straight forward way to code these? Our patients come in either for a first visit - usually prior to 8 weeks for a confirmatory visit. These are usually billed at a 99202 or 99212-99213, (depending on what the doctor did), along with the pregnancy test and then are given an appointment for their first PNV which begins the global period. These visits I understand.  However, some patients, those usually at 8 weeks or more come in and have a confirmatory pregnancy test and then the OB record is started on the same date. I have been told if they are new patients (to the practice) the doctors should bill the appropriate new pt E/M - which usually is only a 99202 due to lack of an HPI in the documentation (although the rest of the chart documentation could support at least a 99204). I have also been told that if this is an established patient and the OB record has been started, then this visit would be considered part of the global OB package and we only bill for the pregnancy test. The doctors also use the amenorrhea diagnosis too for the E/M and use the V72.42 for the pregnancy test - which code should they be using for the E/M charge?

I am responsible for teaching the doctors the correct way to code their office visits and I am not sure if this is correct - and if not, I would like to know exactly what is the correct way to bill these initial OB visits! Also if you have any type of documentation that shows the correct way that would be helpful to give to the doctors and to show to my manager.

Thanks for any help I get to understand the correct way to bill these visits!


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## bonzaibex (Dec 3, 2012)

If the OB record is initiated at the time of the encounter, you may not bill for a separate E/M code.  It does not matter if the patient is new or established.  The chart documentation for that initial 99202 would have to be able to stand alone without crossing components over into the initial OB visit, that's tough to do.  

The short answer is to never do a pregnancy confirmation visit and an initial OB visit at the same encounter.  But you have to be careful of that word "never" and making this a blanket protocol.  Don't forget that the service billed has to be medically necessary.  If a pregnancy has been confirmed by another healthcare provider, and assuming you have access to that record, is it medically necessary to re-confirm it?  No, it isn't.  You doctor may think differently, but if so, that means s/he is confirming all pregnancies no matter what, and when something is done routinely and all the time, it's now part of your global service.  

My advice is to schedule a Pregnancy Confirmation visit for patients who have done a home pregnancy test only.  If a patient states the pregnancy has been confirmed by another healthcare provider, tell her she needs to bring in a copy of that record, and schedule her for an initial OB visit.  If she forgets to bring the copy with her, your provider can decide to limit the appt to a prenancy confirmation only and reschedule the initial OB.  Or s/he can do the usual pregnancy test and the initial OB visit, and bill the pregnancy test only for that encounter.  

I have also been told in the past that a diagnosis of amenorrhea should only be used if the patient has missed 3 periods in a row, although I recently attended a conference where the ACOG rep said that's been upped to 6 missed periods in a row.  If the patient has not missed more than 3 or 6 periods, then you should use 626.4 instead.  The V72.4x code can apply to the E/M as well as the pregnancy test itself.  

As far as documentation to present to your providers, if you have or if your doc has an ACOG web site login, search there.  They must have something that addresses this issue.

Becky, CPC


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## jdibble (Dec 4, 2012)

Thanks Becky!  This is very helpful. I appreciate your clear explanation! I don't have a log in to the ACOG, but I will check to see if any one else here does!

Thanks again!


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