Ob-Gyn Coding Alert

Hint: You can report complications before or after delivery

You can receive increased reimbursement when your ob-gyn provides additional visits outside of the normal global ob package, but you-ll have to make sure you-ve coded high-risk or complicated obstetrical care correctly--and that means perfecting your ICD-9 coding skills.

Insist on Perfect ICD-9s You have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code, for example, to demonstrate the reason for the additional service. You can add this to the claim that includes the global service, or you can submit it as an additional claim.

Example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is seen in the office 19 times due to developing pre-eclampsia. After the delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care.

The documentation for three of these visits supports reporting 99212 (Office or other outpatient visit for the evaluation and management of an established patient - Physicians typically spend 10 minutes face-to-face with the patient and/or family), while three of the visits have more extensive documentation that supports reporting 99213 (Office or other outpatient visit for the evaluation and management of an established patient - Physicians typically spend 15 minutes face-to-face with the patient and/or family).

In addition, after delivery, the patient experiences prolonged pain and irritation due to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. Finally, the ob-gyn rechecks the patient at her six weeks postpartum visit.

Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services, as well as the diagnoses that depict why the patient required the additional services.

Note: You cannot use the diagnosis code 650 (Normal delivery) if there were any problems during the delivery episode. In this case, the patient was pre-eclamptic, which would have complicated both the pregnancy and delivery. Don't forget: You should also include the code that reports the outcome of the delivery.

Heads up: Notice the fifth digits of these ICD-9 codes. The digit -3- that occurs in most of these codes has become a -4- in the last ICD-9 code to indicate a postpartum condition rather than an antepartum one. Using -3- indicates she did not deliver during the hospital stay, says Jenny Baker, CPC, professional services coder at Women's Health at Oregon Health and Sciences University in Portland. When to Submit Your Claim You have two options as to when to submit your claim--after the patient delivers, when you can count the number of visits beyond the [...]