Ob-Gyn Coding Alert

Hint: V72.42 will soon solve your 'confirm the confirmation' problems

If your ob-gyn simply confirms a patient's pregnancy during an office visit, you'll be able to report V72.42 (Pregnancy, confirmed) as of Oct. 1. Until then, test your ob record skills with these four scenarios.

Scenario 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?

Answer: At the next visit.

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 if some discussion about her health took place.

Report 626.8 (Missed period) as the primary diagnosis code linked to the E/M code. You should also consider listing V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy) as a supplementary diagnosis code for the urine test that confirmed the pregnancy (remember that you must code what you know at the end of the visit).

In the future: As of Oct. 1, 2005, you'll have the new ICD-9 code V72.42 (Pregnancy, confirmed). You will use this code when your ob-gyn simply tests to see if the patient is pregnant. This code will go on both the E/M code and the urine test, because you'll be coding for what you know at the end of the visit. You won't need any other V codes. Remember, until Oct. 1, you should follow the advice stated above.

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

Answer: At the next visit.

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.

Remember to code any complaints, such as malaise, general fatigue, spotting, nausea, vomiting, pelvic pain, etc., that the patient presents with, says Michelle Rogers, office manager at Glen Lakes Ob-Gyn PA in Dallas. You can report 99384-99386 for new patients or 99394-99396 for established patients.

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

Scenario 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: During this visit.

Because another physician made the diagnosis, your ob-gyn probably wouldn't need to "confirm the confirmation." Therefore, he would begin the ob record, which means this service is part of the global ob package.
 
Tip: "We confirm intrauterine viability before we begin the barrage of ob coordination," Rogers says. "We want to be confident the pregnancy will proceed, so that we can eliminate the hardship of a lost pregnancy compounded with information and timetables that are now useless - this doesn't mean we haven't lost pregnancies; it just means we try to postpone the situation if we can."

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

Scenario 4: Your practice scheduled an initial ob appointment for a pregnant patient (who confirmed her pregnancy at home), but she can't wait to have some of her questions answered. She wants to come in earlier for counseling. The ob-gyn would perform no initial visit or ob panel blood work during this visit. When should you start the ob record?

Answer: This scenario could go either way.

Normally, carriers consider all counseling related to a pregnancy included in the global ob service. "If the patient had significant health reasons to warrant counseling, I would wrap this visit into the global care of the patient," says Cheryl Ortenzi, CPC, coding and compliance officer at Affiliated Practice Groups in Brockton, Mass.

However, if you want to report this separately, you'd report an E/M code such as 99201-99205 for a new patient, based on the time the ob-gyn spent with her. The ob-gyn must document the duration of the counseling visit. "The ob-gyn might ask, does the patient intend to keep her pregnancy? Are there extenuating circumstances about high-risk situations, such as drug abuse, need for genetic counseling, or current high-risk medications?" Rogers says.

If the patient is established, you'd report an established patient E/M visit (99211-99215). If a nurse who was not a certified nurse midwife or a nurse practitioner saw the patient, you must use 99211 for the encounter.

As far as a diagnosis code, you might try V65.40 (Counseling NOS) or V65.49 (Other specified counseling), but carriers don't usually allow you to use these codes as the primary diagnosis.

Also, if the ob-gyn discusses genetics with the patient, you can use V26.3 (Genetic counseling and testing) instead. (See the article on new ICD-9 2006 genetic code changes included in this issue.)