Ob-Gyn Coding Alert

Question: At a recent medical seminar, the speaker suggested that proper billing for ob patients included a separate charge for the first exam by the physician and then billing the appropriate global fee thereafter. I disagreed with this suggestion because page 201 of the CPT manual clearly outlines that antepartum care includes the initial and subsequent exams. Is there a definitive answer to this?

Michigan Subscriber

Answer: As you point out, the CPT book clearly states that the global obstetric package includes the initial history and physical. The question is then, is the visit at which the pregnancy is diagnosed part of the global or a separately billable service? The answer depends on the patients presenting complaint or the reason for the visit and whether the ob record was initiated at that visit. If the patient comes in knowing that she is pregnant through a factual source (including a home pregnancy test), you are free to do another test to confirm the pregnancy, but if you initiate the ob record at this time, the whole visit is part of the ob global package.

Initiating the record means starting a file, the patient discussing her visit schedule with the nurse, etc. In addition, confirming pregnancy in this instance is a low-level E/M service unless other complaints not related to pregnancy are addressed at the time of the visit. Some practices simply have the patient come in for a confirmatory lab test and then schedule the first ob visit. If the patient does not know she is pregnant and you diagnose pregnancy at that visit, it can be coded outside of the global package, but again, only if the ob record is not initiated at that visit.

Should the patient come in for her annual examination and at that time pregnancy is diagnosed, you can bill for it outside of the global ob package, but once again, do not initiate the ob record at that visit. Schedule her first ob visit for another day.