# Initial ob antepartum care



## hlleary (Jul 30, 2009)

When does the antepartum care begin, when the patient comes to the office the first time & a prenatal record is started, but no confirmation of pregnancy has been done.  Do you do a regular new patient or established patient E/M code, or is that the start of the antepartum?  If the patient comes to the office with a confirmation of pregnancy already, do you begin right away with antepartum care global then?


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## imjsanderson (Jul 30, 2009)

Subject	Bill separate confirmatory pregnancy visit if OB record isn't initiated
Source	Coder Pink Sheets: Ob/Gyn
Publication	OB/Gyn Coder's Pink Sheet, February 2008, Vol. 7, No. 2
Effective Date	Feb 1, 2008
Publish Date	Feb 1, 2008

Even if your patient already knows she's pregnant (e.g., because a home pregnancy test was positive), you should report a visit separately if the OB record was not begun. 
According to guidelines from the American College of Obstetrics and Gynecology (ACOG), "if a patient presents with signs or symptoms of pregnancy and the patient is there to confirm pregnancy, this visit may be reported with the appropriate level of E/M services code. However, if the OB record is initiated at this visit, then the visit becomes part of the global OB package and is not billed separately."
Similarly, "if the physician is confirming a pregnancy which has been diagnosed by some other source (including a home pregnancy test), then the physician may report the appropriate level of E/M services code."
In addition, ACOG says that "the physician may draw blood and prescribe prenatal vitamins during this initial visit and still report it as a separate service as long as the OB record is not started." ACOG says.
The key is the phrase â€˜Ob record not begun' or â€˜Ob record not initiated.'  That essentially just means the global OB period has not yet started (see below).
What is a confirmatory visit? According to ACOG, the confirmatory visit is the E/M service code with the earliest date of service in a pregnancy term when reported in an office setting and with an obstetrical related ICD-9 code as defined by the policy. Payers may be all over the map when it comes to separate payment for these visits, says Teresa Thompson, CPC, coding consultant, Sequim, Wa. "While some payers won't pay without V72.42 - and then only if the OB record wasn't initiated (e.g., UnitedHealthcare, see box below) - others may pay for the visit separately even if the OB record was initiated, while others won't pay separately for the visit under any circumstances," Thompson says.
ACOG maintains that you can bill separately if the OB record hasn't been initiated even when the patient has already knows she is pregnant (because she took a home pregnancy test, for example).
Separately payable confirmatory visits usually low level: Typically, if the physician evaluates the patient and determines she is pregnant but does not start the OB record, it's usually a low-level E/M service. However, the visit during which the ObGyn initiates the OB record usually involves a high-level comprehensive examination (which is factored into the global OB care and shouldn't be reported separately). 
If, for example, the patient sees the ObGyn for her annual gyn examination during which the pregnancy is discovered, the ObGyn might schedule the first OB visit in a couple of weeks, and you could report the routine preventive service for that encounter separately. 
You would use V72.42 as the main diagnosis code on the problem oriented E/M service (99201-99215). The other codes, such as V70.0 (routine general medical examination at a health care facility) and V72.31 (routine gynecological examination) would be linked to the preventive visit code. 
If the ObGyn performs a pregnancy test that does not return positive, other diagnosis codes apply. For unconfirmed exams or tests, report V72.40. For tests that return negative, report V72.41. Of course, these visits are payable, as there is no global OB they might be included in.
"Initiating the OB record" defined
Global OB care begins on the visit in which the first OB record is initiated. During such visits, the ObGyn may:
•	Order blood work 
•	Take baseline height, weight and blood pressure readings, 
•	Prescribe prenatal vitamins 
•	Discuss pregnancy with patient or have nurse do so.
You have to use a different diagnosis code to report visits during which the OB record is initiated. Instead of V72.42, the correct code is V22.0/V22.1 (supervision of first/other normal pregnancy).
The information contained herein was current as of the publication date. Â© Copyright DecisionHealth, all rights reserved. Electronic or print redistribution without prior written permission of DecisionHealth is strictly prohibited by federal copyright law.


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## t.rock.tara (Dec 4, 2009)

Hi imjsanderson,

For the situation mentioned above. Do you think it is okay to still bill comfirmation of pregnancy if my documentation states (not on ACOG forms):

+ preg test on 11/25/09 - thru (other medical clinic name here)

and also the M.A. put this for Chief Complaint,... confirmation of pregnancy start care...LMP, EDC, ....

I hope this question made sense and that you will see this post. 
Thanks for any help you can give me!


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## imjsanderson (Dec 9, 2009)

If the patient's pregnancy was already confirmed at another clinic, then your physician knew she was pregnant (not from a home test) and I would say this would be part of global.  If your clinic confirmed the pregnancy, then I say it is okay to bill this with V72.42.  Does this help?


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## t.rock.tara (Dec 9, 2009)

That does answer my question. Thank you. I'm sorry I should have asked this previously but would the Health Dept also count because the confirmation is coming from some type of medical staff background? Thanks again for all your help.


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## bonnyr (Dec 9, 2009)

I've always beentold that it all depends on the prenatal record.  If the provider began the prenatal record, then it's included in the global whether the pregnancy test was done then or not.

If no prenatal record was started, then it would be a new patient E&M code.
Bonny


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## imjsanderson (Dec 10, 2009)

Tara, if the pregnancy was confirmed by any medical means (yes the Health Dept) and the physician was aware of this then the physician would begin the OB record right away.  You would only charge a confirmation of pregnancy visit if your clinic confirmed it and it was not previously confirmed.


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