Ob-Gyn Coding Alert

Question: If a patient comes in for an antepartum visit and the provider documents that he spent 30 minutes on diabetic education, should I include this with the visit, or can I bill for the antepartum as well as a counseling CPT code?


West Virginia Subscriber


Answer: How you should report this scenario will depend on the payer.

If this is a payer that requires you to itemize all services, you will only get paid for one service that day. In that case, you should lump everything into the E/M level you will be billing (such as 99213, Office or other outpatient visit for the evaluation and management of an established patient) to cover both the antepartum visit and the diabetic counseling.  

If you are billing globally, you can code the diabetic education, but you will not be billing for the antepartum service. Keep in mind: For education, you have to sort out whether:
 
- the patient is diabetic or has gestational diabetes, or

- the ob-gyn is counseling the patient about avoiding gestational diabetes (included in antepartum care).  If she has the problem, you bill a problem E/M, the level of which matches the documentation (your ob-gyn must document the counseling content). Modifier 24 (Unrelated E/M service by the same physician during a postoperative period) does not apply to this scenario because the patient has not delivered yet. But some payers may recognize modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) because the counseling took place at the time of the antepartum visit even though you are not billing for that part of the encounter separately.

Bottom line: Some payers will reimburse for this, while others will not. If the payer does deny the service, you should be prepared to bill the patient for it.