Pick Your Pregnant Patient Annual Visit Codes Wisely
Published on Mon Jan 01, 2007
Heads up: Pregnancy won't always be your primary diagnosis The starting line for global maternal care isn't always clear-cut when a patient presents for an annual visit.
She may or may not know if she's pregnant, but you should stick to one rule -- you must code what you know at the end of the visit. Attack This Annual-Exam Scenario Annual visits often lead to confusion when your ob-gyn establishes a patient's pregnancy. You should choose from a range of different E/M codes according to three scenarios:
- a patient's annual visit leads to a diagnosis of her pregnancy
- she arrives knowing that she is pregnant
- the ob-gyn eliminates other possible diagnoses. Scenario 1: Your ob-gyn diagnoses pregnancy during a patient's annual exam. Can you still report the annual exam?
Solution 1: Yes, you can still report the annual exam, says Rachel Morales, CPC, coding specialist at FMC Management in Amarillo, Texas. You need only link the pregnancy test result diagnosis to the diagnostic test. Your claim should look like this:
- the annual exam (99384-99386 for new patients or 99394-99396 for established patients) linked to V72.31 (Routine gynecological examination)
- the diagnostic test (for instance, 81025, Urine pregnancy test, by visual color comparison methods) linked to V72.42 (Pregnancy examination or test, positive result). Don't miss: Reporting the routine pregnancy codes V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy), or even V22.2 (Pregnant state, incidental), is optional. Bottom line: The ob-gyn is not monitoring the pregnancy at this visit, and you have documented what you know at the end of the visit by using V72.42, says Sarah Chapman, administrative assistant/medical coder for Etowah Valley Ob/Gyn in Cartersville, Ga.
As for the ob record, you should not begin it until the next visit. Otherwise, carriers will consider the whole visit part of the global ob service.
Think of it this way: -We-ve told our doctors to not start the ob flow sheet until after the first visit where the doctor confirmed the patient's pregnancy. The next visit he schedules after the confirmation is the start of the ob flow sheet,- Morales says. -This prevents visits where patients come in to start prenatal care, only to find out they are not pregnant,- Chapman adds.
Keep in mind: You must report what you know at the end of any visit. If the ob-gyn knows the patient is pregnant, you must report the patient as pregnant and include the appropriate pregnancy diagnosis. If you have a positive pregnancy test, that code will be V72.42. What to Do When Patient Knows She's Pregnant Scenario 2: The patient comes in for her annual examination, already knowing she is pregnant. Can you still report the patient's annual exam?
Solution 2: [...]
