Ob-Gyn Coding Alert

Learn what clues to look for when reporting 76811 and 76812   In the last issue, you learned how to tackle multiple-gestation deliveries, fetal non-stress tests, and amniocentesis coding dilemmas -- but if you-re still curious about ultrasounds and different-day deliveries, you-re not alone.      
Our experts give you all the answers you need to perfect your multiple- gestation claims.   Issue 1: Different-Day Deliveries   Occasionally, multiple-gestation babies will be born on different days. -We have seen two delivery days in our office,- says Pat Larabee, CPC, CCP, coding specialist at InterMed in South Portland, Maine.      
For example, a patient is at 38 weeks gestation and carrying twins in two sacs. One membrane ruptures, and the ob-gyn delivers the baby vaginally. Two days later, the second ruptures, and the second baby delivers vaginally as well.
     
Solution: You should report the first baby as a delivery only (59409) on that date of service, says Peggy Stilley, CPC, ASC-OB, OGS, clinic manager for Women's Health Care Specialists in Tulsa, Okla. For the second, you should bill the global code (59400), assuming the physician provided prenatal care, on that date of service, she adds. -The reason not to bill the global first is that you are still offering prenatal care due to the retained twin,- Stilley says.
     
-I promise that you will have to attach a letter explaining the situation to the insurance company because the appropriate diagnosis for each delivery is -twins,- even though the ob-gyn has delivered only one,- Stilley says. -Your payers will require you to use the outcome codes (V27.2, Twins, both liveborn), but you may have to explain that it is still -twins- even though only the first [baby] was delivered.-   Issue 2: Sorting Out Ultrasound Codes   Invariably, multiple-gestation pregnancies mean multiple ultrasounds. Generally, ob-gyns use obstetric ultrasounds to show viability, the number of fetuses, fetal position, amniotic fluid volume, fetal measurements, placental location, and fetal weight estimation and allow basic anatomical review. In this case, you must choose the codes based on fetal age:
- 76801 -- Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation - +76802 -- ... each additional gestation (list separately in addition to code for primary procedure) - 76805 -- Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation - +76810 -- ... each additional gestation (list separately in addition to code for primary procedure).  
Example: If the physician orders an ultrasound in gestation week 12 to confirm the presence of triplets, you [...]