Ob-Gyn Coding Alert

Postpartum office visits typically include a discussion about contraception. Often this is a simple discussion, with the patient stating that she wishes to go back on oral contraceptives. However, when a patient says she is considering tubal ligation, a subdermal implant, intrauterine device or other form of contraception, the simple discussion becomes a much more involved process, for which there is no additional reimbursement for time spent with the patient. An alternative to discussing contraceptives in the postpartum visit is scheduling a follow-up visit to discuss and prescribe contraception.

Thomas Kent, CMM, principal of Kent Medical Management in Dunkirk, MD, and a former practice manager, offers the following example: He recently completed a large coding review for a five-doctor, three-nurse/midwife practice. The review found that they were losing significant reimbursement potential in the way they conducted postpartum contraceptive counseling.

When they conducted postpartum checks, says Kent, they always asked the patient, What are your plans for contraception? This works fine when the patient says she wants to resume her previous method. But what about when a patient says, I think I want to get my tubes tied? This becomes a much longer discussion.

Time is Money

Kent reasons that since a discussion about tubal ligation or other more involved methods of contraception can easily take 20 minutes or more of unscheduled time, physicians lose both money and time with the postpartum visit. He suggests physicians schedule a follow-up visit strictly to discuss contraceptive options. That way, the patient is given the time needed to learn the full range of options, and practices stay on schedule and have a much greater chance of being reimbursed for their time spent with the patient.

Clearly, doctors want to do what is convenient for their patients and themselves. Very often its easier to discuss contraceptive care at the time of the postpartum follow-up. But a strategic decision must be made on how best to serve patients while ensuring the maximum reimbursement. With global ob care now paying out as little as $1,500 total, often with no differential for a cesarean section or other additional procedures, practices need to be mindful of extra time spent in postpartum care.

Doctors must ask themselves, says Kent, Will I risk losing this patient by insisting on an additional office visit to discuss contraception? I dont think they will. Considering the money and time now being lost through extended contraceptive counseling, my bet is that at worst a break-even point would be reached.

Use Modifier -24 During Global

If the follow-up to discuss contraception occurs within the normal global period, which is six weeks for most payers, use 59400 (routine obstetric care with [...]