Ob-Gyn Coding Alert

Learn how not to misuse the new 'pregnancy confirmed' code Don't base your ob-gyn coding on myths and assumptions - if you do, you're asking for denials and lost reimbursement. Bust through the following four global ob myths and learn how to correctly report V72.42 when it becomes available Oct. 1. Myth #1: You can initiate the ob record after both the nurse and ob-gyn see the patient. Setup: Many coders believe that when your ob patients first meet with one of your nurses for the ordering of blood work, you should report a minimal visit (99201 or 99211). Then, when the patient is at 11 weeks, you set this patient up to meet with your ob-gyn for the first time to determine a viable pregnancy. For that service, they recommend you report 99203/99204 or 99214/99215 and include any visits thereafter as part of the global ob package.

The reality: If you're reporting your physician visits this way, you're incorrectly coding under everyone's rules. If you were to be audited, your payers would consider each and every one of these ob-gyn visits a part of the global, which means you can expect to give some refunds.

Let's say your nurse does a prenatal interview that lasts about an hour. She goes over risks, things to watch for, what is normal, and orders prenatal labs, urine cultures, and glucola.

In this case, you would report an established visit code (99211). The next visit with the ob-gyn (or nurse practitioner) would then begin the ob record, says Shari Kheul, CCS-P, coding and reimbursement specialist at Women's Health Services in Clinton, Iowa.

Note: In addition, if the nurse has already seen the patient, you cannot report the physician visit using a new patient code.

Rule of thumb: When you initiate the patient's antepartum record, then you'll always include that visit as part of the global service. You may be able to report the first visit when the ob-gyn or nurse performs a pregnancy test outside of the global, but you should consider all other visits related to pregnancy a part of the global package.

Myth #2: To be reimbursed for the initial ob workup, you should report 626.0.
 
Set up: When an ob-gyn sees an ob patient for the first time, some coders say that the only way to be paid for the first initial workup is to use 626.0 (Amenorrhea [primary] [secondary]). And only after that visit can you start the global ob package.

The reality: First, you should know that amenorrhea, by clinical definition, means no menstrual periods for six months or no periods for three months with documented irregular periods. You shouldn't use this code at a visit in which the ob-gyn diagnoses pregnancy. [...]