Ob-Gyn Coding Alert

When you report split antepartum care, where does the initial "pregnancy" visit fall? The answer depends on when the physician establishes the patient is pregnant.
 
Because ob-gyns often consider home pregnancy tests unreliable and require a confirmation test at the first visit, you may wonder if this first visit starts the ob package. If the patient presents not knowing she is pregnant, do not include the visit in the antepartum care code. You should use an E/M code (99201-99215) instead. On the other hand, if the patient knows that she is pregnant, even if she bases her knowledge on a home pregnancy test, you should consider this the first ob visit, according to the American College of Obstetricians and Gynecologists (ACOG).
 
You can also determine whether the visit counts toward the ob record by looking at the diagnosis. If the patient doesn't know she is pregnant and presents for a visit because she has missed her period, the ob-gyn will perform an examination and link the E/M to the diagnosis for missed period (626.8, Disorders of menstruation and other abnormal bleeding from female genital tract; other). In contrast, suppose a patient who has tested positive using a home pregnancy test kit presents to confirm her pregnancy. The physician takes a urinalysis (81025, Urine pregnancy test, by visual color comparison methods) at the beginning of the visit, confirms the pregnancy and begins an in-depth visit discussing prenatal care and concerns with the patient. In this case, the ob-gyn reports a pregnancy diagnosis, which means he has begun antepartum care, and you should count the visit as part of the antepartum care package.
 
Before you start tallying an ob visit for every patient who presents knowing she is pregnant, however, call your major carriers and see if they follow these rules. Some payers include the first visit in the antepartum package, and some don't. Because policies can vary significantly, the only way to ensure you're capitalizing on accepted coding practices is to contact your insurance companies.