Ob-Gyn Coding Alert

Surprise: You shouldn't apply an E code if an auto accident affects the fetus Reporting obstetrics may be something you do every day, but that doesn't mean your coding will be error-proof. Review the following three frequently asked ob coding questions -- answered by our experts -- and discover solid advice on what an ob package includes, what hospital services you can report, and what to do if an ob patient is in a car accident. FAQ 1: What's Included in the Ob Package? Question: What services are considered part of the global maternity package (for example, routine dip urinalysis, blood draw, etc.)? CPT includes a definition of services that are part of the global package in the "Maternity Care and Delivery" section immediately before 59000 (Amniocentesis; diagnostic), says Peggy Stilley, CPC-OGS, ACS-OB, clinic manager at OU Physicians in Tulsa, Okla. The guidelines explain what is included in antepartum, delivery and postpartum services. Glitch: Some payers may try to include some of the tests performed as screening during pregnancy in the global package, Stilley says. Example: The CPT definition states that you should include a routine chemical urinalysis to check for glucose and protein. The package, however, does not specify a dipstick. Plus, it does not specify under microscopy or another method. The definition simply directs you to include a routine urinalysis, which is a chemical test. If that is what your ob-gyn is doing, regardless of the method used, you should include the urinalysis 81000-81003 (Urinalysis, by dipstick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents ...) in the obstetric global package. Don't miss: Any other test that the ob-gyn performs on a patient during her pregnancy is probably excluded from the global package under CPT guidelines. But you may run into complications. Example: A physician was getting very nervous because he had been sued previously, so he decided to do an alpha-fetoprotein test (82105, Alpha-fetoprotein [AFP]; serum) on all pregnant patients. The insurance carriers saw that this ob-gyn billed the AFP regularly for all patients and notified him that they were no longer going to reimburse for that service. They stated that the AFP was now recognized as part of his routine obstetric package care, and they were rolling it in. Unfortunately, this is the view of many payers. Watch out: If your practice consistently bills for things without good medical indication for the particular patient, the insurer will tend to view the service as part of your global package and refuse to pay for it. In other words, you are not performing the service because the patient needed it -- you are doing it on [...]