Ob-Gyn Coding Alert

Question: How should I bill for a pregnant patient who has been scheduled for her eight-week initial ob appointment but can't wait to have some questions answered and wants to come in earlier for a consultation? Her pregnancy has been confirmed at home, and no initial visit or ob panel blood work would be done at the consultation.

Kansas Subscriber

Answer: Normally, carriers consider all counseling that is related to pregnancy included in the global ob service.

If you are billing separately for this service, however, this would not be a "consultation" as defined by CPT because the patient is referring herself to the ob-gyn to have her questions answered. Therefore, you would be reporting an E/M code.

If the patient saw the physician for this visit, you could report a new patient code (99201-99205) based on the time spent with her if the physician documents the duration of the counseling visit. If the patient is established to your practice, however, you should bill an established patient E/M visit (99211-99215).

On the other hand, if the patient saw a nurse for this visit, you would be confined to using an established patient code. And unless the nurse is a certified nurse midwife or a nurse practitioner, you must use 99211 for the encounter.

Similarly, selecting a diagnosis code may present further questions because the ob-gyn is seeing the patient to provide advice and counseling rather than antepartum care. You could try V65.40 (Counseling NOS) or V65.49 (Other specified counseling), but carriers generally don't allow you to use these codes as the primary diagnosis. But if this is the only reason for the visit, you could use either code. In addition, if the ob-gyn discusses genetics with the patient, you might use V26.3 (Genetic counseling and testing) instead.