Overcoming the Reimbursement Challenges of the Diabetic Ob Patient
Published on Sat Jan 01, 2000
Pregnancy with diabetes as a complicating factor requires that extra monitoring and often additional procedures be conducted by the ob-gyn. Two to three percent of all pregnancies have diabetes as a complicating factor, with more than 90 percent of these occurring as gestational diabetes. When managing either gestational or preexisting diabetes in the pregnant patient, additional care and monitoring are required to ensure a safe and relatively routine pregnancy and delivery. But to hear coding experts tell it, monitoring the pregnancy can be the easy part. The difficulty arises when ob-gyn practices seek reimbursement for the wide range of extra time and services required for the diabetic pregnant patient.
The biggest difference between a diabetic and non-diabetic ob-gyn patient, with regard to treatment, is that the diabetic patient must be in constant communication with her doctor. Pregnant diabetic patients fall into one of the following categories, each of which requires substantial management on the part of the physician:
1. Established diabetes type I or II, controlled. These patients are likely to be the easiest to monitor and control, as they are already familiar with the necessary methods of managing their preexisting diabetes.
2. Established diabetes type I or II, uncontrolled.Patients whose preexisting diabetes is not being controlled through medication and diet will need additional counseling and monitoring. Pregnant women with uncontrolled diabetes tend to have bigger babies, thus cesarean sections are more common. Gestational diabetes can often go undetected well into the pregnancy. Patients new to diabetes require significant counseling and education in order to establish a controlling regimen of care throughout the pregnancy.
Building a Case for Reimbursement
Extra office visits required for a diabetic ob-gyn patient are a common sticking point when it comes to reimbursement. Diabetics tend to be seen much more frequently because of risks to mother and fetus. It is typical for the obstetrician to see the patient every other week for the first seven months, then even more frequently during the last two months of pregnancy. In some cases, during the last two months of pregnancy, the patient goes to the hospital for a fetal non-stress test (59025-26 [professional component]) every other day.
The issue with a diabetic ob-gyn patient, says Melanie Witt, former program manager of the department of coding and nomenclature at the American College of Obstetricians and Gynecologists (ACOG), is that the ob-gyn is essentially taking over the diabetes management and should be reimbursed for it. An office visit for the management of diabetes is not included in the global ob package and should be billed as an E/M encounter, says Witt. The real issue is not how to code, but how to get reimbursed. It is an issue of coverage [...]
