Ob-Gyn Coding Alert

Tip: Global code means ob-gyn did the delivery and provided all antepartum care.

Last month, you took a four-part situational challenge asking, should this visit be inside or outside the global ob package? Look at four more scenarios, and see how you fare.

Monitoring the Pregnancy is Key

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?

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

Rule of thumb: The patient is presenting for obstetric care, and the global code choices for this situation all include an initial new patient visit. 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).

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

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 (Other disorders of menstruation and other abnormal bleeding from female genital tract) 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 physician's documentation denotes evidence of cervical dilation or contractions.

ICD-10: When your diagnosis coding system changes in 2013, code 626.8 will expand to two options: N92.5 (Other specified irregular menstruation) or N93.8 (Other specified abnormal uterine and vaginal bleeding). But keep in mind that this may not be your only option. If you check the ICD-10 Index, you will note that looking up the term, "menstruation, suppression," you are directed to code N94.89 (Other specified conditions associated with female genital organs and menstrual cycle). In other words, always check the ICD-10 Index before deciding which code best describes the situation.

Code 649.53 will expand into three options, based on trimester:

O26.851 (Spotting complicating pregnancy, first trimester),

O26.852 (... second trimester), or O26.853 (... third trimester).

Code 640.03 will become O20.0 (Threatened abortion).

Watch Out For Complications

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?

Answer 7: You should report this visit as outside the global ob package, but the payer may deny it as inclusive. Under CPT® guidelines 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.

Think of it this way: The global ob package is for uncomplicated pregnancy with delivery and uncomplicated postpartum care. You should bill any complications that require extra care separately. However, if the payer disagrees and will not consider payment until the patient has delivered, you will have filed the claim within a possible timely filing period that will permit you to appeal the decision after delivery. Remember, many payers consider the antepartum period to consist of 13 visit, and the reason for the visit after the physician initiates ob care does not affect their decision to include them (unless totally unrelated to the pregnancy).

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.

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?

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