# Ob/gyn help



## Shortcakecoder101 (Aug 19, 2016)

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

Thanks!!!


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## Chelle-Lynn (Aug 19, 2016)

Can you be specific on what aspects of the billing or coding you are having trouble with?


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## Shortcakecoder101 (Aug 22, 2016)

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.


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## Chelle-Lynn (Aug 22, 2016)

*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_.


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## Shortcakecoder101 (Aug 24, 2016)

Thx, now my next question is can I bill an office visit with the u/s?


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## Chelle-Lynn (Aug 24, 2016)

Does your office bill globally for the office visits and delivery?


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## Shortcakecoder101 (Aug 24, 2016)

Yes they do


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## Chelle-Lynn (Aug 24, 2016)

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


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## Shortcakecoder101 (Aug 25, 2016)

Thank you, so what if the office doesn't bill global and deliveries. Do I bill office visits for u/s?

Thanks


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## Chelle-Lynn (Aug 25, 2016)

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.


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## Shortcakecoder101 (Aug 29, 2016)

Ok if the documentation states there was E/M then is it ok to bill an ov?

Thanks


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## Cmama12 (Sep 1, 2016)

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.


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## Shortcakecoder101 (Sep 1, 2016)

Can someone tell me the difference between Keystone Health Plan East and Independence BCBS.

Thanks


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## jrhinelander (Sep 14, 2016)

*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


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## Palmtoptiger (Sep 15, 2016)

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,


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## lminneti (Sep 22, 2016)

*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? 

Thanks


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## jrhinelander (Sep 27, 2016)

*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!


Chelle-Lynn said:


> 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
> ...


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## jdibble (Sep 28, 2016)

lminneti said:


> 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?
> 
> 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.


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## DeniseD (Jun 20, 2018)

*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


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