Ob-Gyn Coding Alert

Question: If we bill ob visits separately instead of globally, at what level should the first through third visits be coded? We usually bill the first visit as 99213 and subsequent visits as 99212.

Nevada Subscriber

Answer: When you bill for individual antepartum visits rather than global care, code each visit based on the documentation for that visit. Some physicians will have documented higher levels of care and others lower.

In most cases, a pregnant patient's initial visit involves a comprehensive history and exam and at least moderate complexity of medical decision-making. This visit will likely be a 99204 (Office or other outpatient visit for the evaluation and management of a new patient ) or, for an established patient, 99214 if the payer requires that medical decision-making be one of the key elements. In some cases, the physician may have documented high complexity of medical decision-making, which means the level could be 99215 for the first visit.