# First OB visit



## cynannthomas (Jan 4, 2010)

I have recently heard that some offices code the first OB visit as an annual if it applies since a complete exam & pap are done.  Any comments.  I have not been doing that.  We have been just including this in the global coding.  Thanks!!


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## Lisa Bledsoe (Jan 4, 2010)

IF the OB flow record is not started at the first visit (ie confirmation of pregnancy) we code the appropriate E/M.  Once the flow record is started, it is then part of the global.


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## seniar (Jan 6, 2010)

We bill an annual for every new ob that has not had a papsmear within the last 12 months.  We do not start the flow sheet until their first ROB visit, therefore it is billable outside of the global.


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## Lisa Bledsoe (Jan 7, 2010)

How can you code a preventive when that is not the intent of the visit?  It is not preventive, it is a visit to confirm pregnancy.  Just because a pap is done does not make it an annual exam/well woman exam.  Please explain.


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## mikjad12 (Jan 12, 2010)

My doctor tries to bill a high level E/M for their first OB visit, I believe this is wrong because ob care has been intitiated and once it has been initiated the global has started.


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## christine burnes (Jan 13, 2010)

*Confirmation of pregnancy*

My office bills the appropriate level E/M for the confirmation of pregnancy.  Once the ACOG sheets have been started all other visits should be billed as global unless they are being seen for an acute condition (e.g. uti or vaginitis).
Hope this helps!!


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## dan528i (Jan 17, 2010)

Lisa Curtis said:


> How can you code a preventive when that is not the intent of the visit?  It is not preventive, it is a visit to confirm pregnancy.  Just because a pap is done does not make it an annual exam/well woman exam.  Please explain.



Hey Lisa,
We bill Annual 9938X or 9939X w/ V72.31
and appropriate level E&M usually 99212 or 99213 w/ mod 25 and DX V72.42
(and other dx codes if applicable).
The ptn might be preset for conf of pregnancy BUT if its been other 1year since her last Annual c/u; The doctor has to do a coplete physical w/ PAP/pelvic/ breast exam and etc. AND only then e&m for conf of preg. Also, I recently spoke to a quality control officer from one of the insurence comp. (She verified all of the above to be correct) and also stated that everything must be documented so we use the complette (3pgs ACOG form) and everything was good.
Hope this helps


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## Lisa Bledsoe (Jan 18, 2010)

Daniel - I still don't see how that is appropriate coding.  A complete exam is included in the initial OB visit at which time the OB flow sheets are started...so if the ACOG 3pg form you are referring to is part of the OB record, you can't code anything but global.


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## cmtl (Jan 19, 2010)

I'm with TrueBlue on this one.  The intent of the visit is relevant.  If we know the patient is pregnant the global OB form should be started and it should not be billed separately.


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