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Ob-Gyn Coding Alert

Keep Track of Prenatal Care With Category II Codes

Published on Thu Oct 28, 2004

CPT 2005 also renumbers 6 older codes

If your practice wants to itemize all initial prenatal care visits, then check out the new ob-gyn Category II code, 0500F.

As of Jan. 1, you'll have a host of other new and renumbered Category II codes to choose from. The American Medical Association (AMA) posted the second round of new codes for the year, ranging from prenatal/postpartum care to tobacco use.

Category II codes describe components usually included in an E/M service or the test results part of a laboratory test/procedure. Category II codes collect data about quality of care.

Keep in mind: Some Category II codes may relate to healthcare professionals' compliance with state or federal law. For example, "some HMOs may require ob-gyns to meet certain treatment protocols, and these codes provide a way for ob-gyns to track those protocols without having to flip through the chart to see when something has been done," says Susan E. Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

New Prenatal Category II Codes Are Optional

Four new prenatal and postpartum care visit codes can help you keep tabs on performance measures for preventive care:

  • 0500F - Initial prenatal care visit (report at first prenatal encounter with healthcare professional providing obstetrical care. Report also date of visit and, in a separate field, the date of the last menstrual period - LMP)

  • 0501F - Prenatal flow sheet documented in medical record by first prenatal visit (documentation includes at minimum blood pressure, weight, urine protein, uterine size, fetal heart tones, and estimated date of delivery). Report also: date of visit and, in a separate field, the date of the last menstrual period - LMP (Note: If reporting 0501F prenatal flow sheet, it is not necessary to report 0500F initial prenatal care visit)

  • 0502F - Subsequent prenatal care visit (excludes: patients who are seen for a condition unrelated to pregnancy or prenatal care [e.g., an upper respiratory infection; patients seen for consultation only, not for continuing care])

  • 0503F - Postpartum care visit.

    Remember: You may not substitute them for the regular Category I CPT codes, such as antepartum or postpartum visit codes 59425 (Antepartum care only; 4-6 visits), 59426 (... 7 or more visits) or 59430 (Postpartum care only [separate procedure]). You would report the usual service and then add one of these codes.

    "You can use these codes in a no-charge type of  situation, like a dummy code internal to your own system," says Jaime Darling, CPC, certified coder for Graybill Medical Group in Escondido, Calif. "You can plug in 0503F for postpartum care to show this is why the patient was here and why you didn't bill it out."

    This practice can be especially useful if the patient doesn't stay for his whole global care with your practice, because the ob-gyn can look back through the record and assign the correct component or E/M codes to match up with the visits, Darling says.

    Using Category II codes is optional, and they do not affect payment levels in any way. "There is no wrong or right way to use these codes," Callaway says. "Practices can take advantage of them to gather information in whatever way they feel is most important."

    For instance, suppose you want to track a patient's prenatal care and don't have an electronic health record. When you enter these codes into a transaction entry in the billing program, you may find information regarding a patient's care during her pregnancy, date of her last period, and so on.

    You might use these codes in a hospital clinic to itemize the clinic's services. A Medicaid program might require them (if they too must itemize). An HMO might pressure you to report them for internal use, but if your carrier wants global billing, you won't have to worry about them.

    Renumbered Codes Align to Care Groupings

    In addition to the new Category II codes, CPT has renumbered six older codes that could benefit ob-gyn practices:

  • 1000F - Tobacco use, smoking, assessed

    - Formerly 0002F

  • 1001F - Tobacco use, non-smoking, assessed

    - Formerly 0003F

  • 2000F - Blood pressure, measured

    - Formerly 0001F

  • 4000F - Tobacco use cessation intervention, counseling

    - Formerly 0004F

  • 4001F - Tobacco use cessation intervention, pharmacologic therapy

    - Formerly 0005F

  • 4002F - Statin therapy, prescribed

    - Formerly 0006F.
     
    CPT renumbered the Category II codes to align with types of care groupings. 

    For instance, CPT will use the 0001F category for composite measures when they are developed, and the renumbered tobacco use codes now fall under the "therapeutic, preventive or other interventions" category, etc., Callaway says. "Last year, these codes were introduced, but the feedback these codes provided needed to be more specific - hence the new codes."

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