Ob-Gyn Coding Alert

When separately reporting visits,  know exactly what your payer means If a pregnant patient moves out-of-state mid-pregnancy, do you know how to report the services your ob-gyn provided up to the date of the move? Prepare for these situations by adopting the following approach. Tip: For 1-3 Visits, Rely on Office E/M Codes If your ob-gyn sees a patient for only one to three antepartum visits, you need to report the appropriate E/M codes to be reimbursed.
 
Pitfall: For the first ob visit, don't automatically look at a level-four established patient visit (99214, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity).

You won't have a set E/M code for the patient's first visit, because your patient could be new to the practice, for example, or the first visit may actually meet the criteria for a level-five established visit. Therefore you should look to the entire code series (99201-99205 for new patients, 99211-99215 for established patients) as possible options.
 
For the second and third visits, your coding options are more limited. Medicare values the follow-up visit as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...), so this code is your best bet for each of these visits.
 
In some rare circumstances, such as when the patient has absolutely no problems during the visit, however, you may also report 99212 (Office or other outpatient visit for the evaluation and management of an established patient ... Physicians typically spend 10 minutes face-to-face with the patient and/or family) for each visit, says Becky Rood, a biller at the Ob/Gyn Associates of West MI, PC in Muskegon, Mich.
 
If the patient's pregnancy is without complication, your diagnosis would be either V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy), Rood adds. Tip: Anticipate Using Antepartum Codes for 4-6 Visits Four to six visits mean that you'll be flipping through your book to the maternity care and delivery section - particularly the antepartum codes.
 
"We would report 59425 (Antepartum care only; 4-6 visits), a code that represents the total services rendered by our ob-gyn," says Velvie Burson, practice manager at Carrolton Ob/Gyn in Georgia. This means that you'll only report one unit of this code.
 
Note: Your diagnosis will be the same (V22.0 or V22.1) unless the patient has any problem or complication. Tip: Prod Payer for Clues for 7+ Visits You'll find more variation in your coding choices if your patient leaves your practice after seven or more visits. CPT has a code specifically for seven or more visits: 59426 (... [...]