Ob-Gyn Coding Alert
Distinguish Between Your PCPs and Ob-Gyns Before Using O Codes
Question: My office has primary care physicians (PCPs) and ob-gyn doctors. We have a patient that saw her PCP on 11/2/16 and PCP noted normal pregnancy, except for hypertension, and then she also discusses calf pain. However, the patient doesn’t see the ob-gyn doctor in our group until 11/16/16 to confirm her pregnancy. Then, the first OB visit/start of prenatal flow sheet is set for 11/28/16.
Can we use the pregnancy O codes on the PCP visit on 11/2/16 even though we are going to bill out the confirmation code Z32.01 on 11/16/16 with the specialist?
Massachusetts Subscriber
Answer: The PCP diagnosis will be Z32.01 (Encounter for pregnancy test, result positive), not an O code since the PCP is not providing ob care. If the PCP has already diagnosed pregnancy, you should not be doing a repeat confirmation test and the visit on 11/16 is not medically indicated.
If she came in to the PCP with a home pregnancy test and the PCP did not do any confirmation test, the PCP will bill only for the care given based on the presenting problem (such as calf pain, M79.66- or hypertension, I10) with an optional secondary diagnosis of pregnancy not confirmed (Z32.00) You can then perform a confirmation test on 11/16 and use the Z32.01 code.
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