Ob-Gyn Coding Alert

Key: Was ob-gyn monitoring the pregnancy?

Do you know whether you should include or exclude a visit from the global ob package (59400-59622)? Find out with this quick coding challenge.

Decide If Visit is Outside Global Ob

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

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).

Home Pregnancy Test? Count This Visit This Way

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?

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.

Consider This Irregular Periods Visit

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?

Answer 3: You should count this visit as outside the global ob package. Since the reason for this visit is not to verify whether the patient is pregnant, you should not count this as part of the global ob package.

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).

Tread Carefully For This Scenario

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?

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 initiate any activities that would signal the start of global care such as doing a complete history and exam or starting the flow sheets.

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 and the reason she is presenting for care.

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.

Note: Try four more scenarios in the next issue of the Ob-gyn Coding Alert.