Ob-Gyn Coding Alert

Hint: Diabetes before pregnancy is different from gestational diabetes Did you know that $100 billion of direct and indirect U.S. healthcare costs per year are related to diabetes? With cash like that changing hands, even a few diabetes coding mistakes, especially those related to pregnant patients, can cost your ob-gyn practice big.

The root of the problem: The main issue with a diabetic pregnant patient is that the ob-gyn is essentially taking over the diabetes management and should receive reimbursement for it, experts say. But how are you going to convince your payer that these diabetes treatment services are separate from the global package and require a higher level of management skill? First, Point Out the Difference The biggest difference between a diabetic and non-diabetic ob-gyn patient is that the diabetic patient must constantly communicate with her doctor.

Pregnant diabetic patients fall into one of the following categories, each of which requires substantial physician management:

1. Established diabetes type I or II, controlled: Ob-gyns can monitor these patients with more ease than uncontrolled diabetes patients. The reason is because these patients are already familiar with the necessary methods of managing their pre-existing diabetes.

2. Established diabetes type I or II, uncontrolled: Patients who cannot control their pre-existing diabetes through medication and diet will need additional counseling and monitoring. Pregnant women with uncontrolled diabetes tend to have larger babies, thus cesarean sections are more common.

3. Gestational diabetes, controlled or uncontrolled: Gestational diabetes can often go undetected well into the pregnancy. Patients new to diabetes require significant counseling and education to establish a controlling regimen of care throughout the pregnancy. Build a Case for Extra Office Visits Extra office visits required for a diabetic ob-gyn patient are common sticking points when you-re seeking reimbursement from carriers.

Why? Ob-gyns see diabetic pregnant patients with much more frequency because of risks to the mother and fetus. Typically, the obstetrician will see the patient every other week for the first seven months, and then even more frequently during the last two months of pregnancy. In some cases, during the last two months of pregnancy, the patient goes to the hospital for a fetal non-stress test (59025-26, Fetal non-stress test; professional component) every other day.

Important: The global ob package does not include an office visit for diabetes management. You should report this as an E/M encounter. For instance, 99212 (Office or other outpatient visit ... established patient, which requires at least two of these three components: problem-focused history; problem-focused examination; straightforward medical decision-making) is generally the standard for the non-global E/M visit. But if the doctor wants to bill for a 99213 (- which requires at least two of these three key components: an expanded problem-focused history; [...]