Ob-Gyn Coding Alert

Here's what to do when ob-gyn simply confirms the confirmation

Take this eight-situation decision challenge, decide whether you would include or exclude the visit from the global ob package, and then weigh your responses against our experts-. You could be missing out on well-deserved reimbursement.

First, Read These 8 Situations

While you review the following common ob-gyn situations, decide whether you would count these visits as inside or outside the global ob package (59400-59622).

Situation 1: The patient presents for her annual exam. The ob-gyn orders a pregnancy test because he suspects pregnancy. Is this visit inside or outside the global ob package?

Situation 2: The patient presents for her annual exam. She tells her ob-gyn that she has taken a home pregnancy test, and it revealed a positive result. Is this visit inside or outside the global ob package?

Situation 3: The patient presents to your office with a history of irregular periods, and she has had no period for one month. Is this visit inside or outside the global ob package?

Situation 4: The patient presents to your office with pregnancy complaints and a positive pregnancy test. Is this visit inside or outside the global ob package?

Situation 5: A new patient transfers into your practice and comes to see your ob-gyn for the first time. She is pregnant and has received care elsewhere. Is this visit inside or outside the global ob package?

Situation 6: A patient presents with complaints of spotting and a missed period. Is this visit inside or outside the global ob package?

Situation 7: A pregnant patient presents for her second ob visit complaining of spotting and abdominal pain. Is this visit inside or outside the global ob package?

Situation 8: A pregnant patient presents for her third ob visit for lactation or nutritional counseling. Is this visit inside or outside the global ob package?

Check Your Answers Against Our Experts-

See how you fared. Here's what our experts had to say:

Answer 1: You should count this visit as outside the global ob package. The ob-gyn is not monitoring the pregnancy during this visit.

Your claim should look like this:

- the annual exam (99384-99386 for new patients, or 99394-99396 for established patients) linked to V72.31 (Routine gynecological examination)

- the diagnostic test (for instance, 81025, Urine pregnancy test, by visual color comparison methods) linked to V72.42 (Pregnancy examination or test, positive result).

Remember: Reporting the routine pregnancy codes, V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy), as a secondary diagnosis is optional, but if you do use one of them, the payer may decide the service should have been included as part of global care. As another option, you could add the diagnosis V22.2 (Pregnant state, incidental).

Answer 2: You should count this visit as outside the global ob package. Again, the ob-gyn is not monitoring the pregnancy during this visit.

You should report the annual exam (99384-99386 for new patients, or 99394-99396 for established patients) linked to V72.31.

Answer 3: You should count this visit as outside the global ob package. -Since the reason for this visit is to verify whether the patient is pregnant, you should not count this as part of the global ob package,- says Arlene Smith, CPC, coding specialist for Washington State Medical Association in Seattle.

You should code this as a new or established patient outpatient encounter (99201-99215) linked to a diagnosis for the irregular periods, such as 626.4 (Irregular menstrual cycle). 

If your ob-gyn orders a pregnancy test during this visit and the result is positive, you should include V72.42 and link it to the lab test code. If your ob-gyn does not confirm the pregnancy but does test the patient, the correct diagnosis code for the test(s) will be V72.40 (Pregnancy examination or test, pregnancy unconfirmed).

Not All Answers Are Cut and Dried

Answer 4: In this situation, you have to tread carefully.

If the patient presents to your ob-gyn simply to -confirm the confirmation,- -you can bill this visit outside the global with V72.42 -- as long as the ob-gyn did not start the flow sheets,- says Maureen Murphy, CPC, coding specialist at Mt. Kisco Medical Group in New York. 

But if the patient has already confirmed the pregnancy herself, you should count this as inside the global ob package (59400-59622). In fact, this is her initial visit.

What's involved: The ob coordination, usually lasting about 30 minutes, includes the ob-gyn reviewing procedure guidelines, including a timetable of when to do lab tests, pelvic exams, amniocenteses, and other ob-related care. Your ob-gyn will also provide vitamins and iron supplements and discuss when to call him. Keep in mind: A nurse or certified nurse midwife can give the patient this information as well. The initial visit included in the global package is not contingent on the physician having seen the patient.

Answer 5: You should count this visit as inside the global ob care.

Rule of thumb: You can report an unmodified global code only if your ob-gyn also does the delivery and provides all of the antepartum care. When the patient transfers into your practice from elsewhere, you can either bill the global package code with modifier 52 (Reduced services) if your payer allows, or your payer may ask you to itemize by billing antepartum care (59425 or 59426) and delivery with postpartum care separately (59410, 59515, 59614 or 59622).

Answer 6: You should count this visit as outside the global ob package. Again, the ob-gyn is not monitoring the patient's pregnancy during this visit.

Because you do not know if she is pregnant, you may submit 626.8 for the missed period, but you have no clear diagnosis code for the spotting other than 626.8 -- unless your ob-gyn confirms the patient's pregnancy during this visit. In that case, the diagnosis code changes to 649.53 (Spotting complicating pregnancy; antepartum condition or complication). Another option might be threatened abortion (640.03) if your documentation denotes evidence of cervical dilation.

Complications Affect Your Global Ob Coding

Answer 7: You should count this visit as outside the global ob package.

You should code any complaints a pregnant patient has, such as malaise, general fatigue, spotting, nausea, vomiting and pelvic pain. -These could be complications of the pregnancy,- Smith says.

Think of it this way: -The global ob package is for uncomplicated pregnancy with delivery and uncomplicated postpartum care,- Murphy says. -You should bill any complications that require extra care separately.-

The diagnosis for the spotting will be 649.53. For the abdominal pain, you should report 646.83 (Other specified complications of pregnancy; antepartum condition or complication) and 789.0x (Abdominal pain) if your ob-gyn does not confirm a threatened abortion.

Answer 8: You should count this visit as inside the global ob package (59400-59622). -This isn't a complication of her pregnancy,- Murphy says. -You should consider this type of counseling as part of routine ob care,- Smith says.