Ob-Gyn Coding Alert

When your ob-gyn simply confirms a patient's pregnancy during an office visit, automatically assuming that you should begin the global record could sacrifice $40-$60 per visit. Test your ob record skills with the following three questions.

Question 1: The ob-gyn sees a patient who knows that she's pregnant via a positive home pregnancy test and simply "confirms the confirmation." When should you start the ob record?

Question 2: A patient comes in for an annual exam, and the ob-gyn diagnoses pregnancy. When should you start the ob record?

Question 3: A patient sees your ob-gyn after her family physician discovered that she's pregnant and wants to have her ob care with your practice. She has been seen by your practice within the last 12 months. When would you start the ob record?

Answer 1: Start the ob record at the next visit, says Angela Maddox, office manager of Pathway Women's Health PLC in Battle Creek, Mich.

If the ob-gyn performed only the urine pregnancy test, you-d report 81025 (Urine pregnancy test, by visual color comparison methods) or possibly a low-level E/M service (such as 99201-99202 for new patients or 99211-99212 for established patients) if some discussion about her health took place.

You will use V72.42 (Pregnancy confirmed) when your ob-gyn simply tests to see if the patient is pregnant. Because you-ll be coding for what you know at the end of the visit, this code will go on both the E/M code and the urine test.

News: United Healthcare (UHC) has announced that it will revise its payment policy for this situation. Effective the second quarter of 2008, UHC will reimburse separately for this E/M visit prior to the ob record initiation -- but only when you link V72.42 to the office E/M CPT code. "This is a welcome change for us," says Rachel Hollis, CPC, billing manager for Galisteo OB GYN Associates in Santa Fe, N.M. "This will help eliminate confusion between the beginning of ob management and the confirmation of the pregnancy." For more info, see UHC's December Network Bulletin or contact your provider representative.

Answer 2: In this scenario, you should start the ob record at the next visit, says Pat Larabee, CPC, CCP-P, coding specialist at InterMed in South Portland, Maine.

"The patient was here for her annual exam, not to start care for her pregnancy," Maddox agrees.

If you began the ob record during the annual exam visit, most carriers will consider the annual exam part of the global ob service. You cannot bill the global service until delivery, but you should inform the insurance company of the pregnancy.

Rule of thumb: Until you know that the patient wants her pregnancy to continue, you shouldn't initiate the global care.

Answer 3: Initiate the ob record during this visit. "The patient is here to start her ob care," Maddox says.

Because another physician made the diagnosis, your ob-gyn probably wouldn't need to confirm the confirmation, Larabee says. Therefore, he would begin the ob record, which means this service is part of the global ob package.

- What's involved: The ob coordination is lengthy, usually lasting 30 minutes or more, and involves going over procedure guidelines, including a timetable of when to do lab tests, pelvic exams, amniocenteses, etc. The ob-gyn will usually provide vitamins and iron supplements and discuss when to call him.