Ob-Gyn Coding Alert

Question: I have an insurance company that does not want to pay for a postpartum urine pregnancy test. It told me the test is included in the global care and would not reimburse this service separately. 


Kentucky Subscriber

Answer: You should look at your records and see how far out from the delivery date the patient is. If you are within the six-week postpartum period, you are probably getting the postpartum urine pregnancy test denied because of medical necessity. If your physician has documented special circumstances for performing this test in the postpartum period, appeal the denial.

When the ob-gyn orders this test to diagnose pregnancy and the global care has not begun yet, you can report the urine pregnancy test code 81025 (Urine pregnancy test, by visual color comparison methods) with a diagnosis of V72.42 (Pregnancy examination or test, positive result) if the result is positive or V72.41 (Pregnancy examination or test, negative result) if it is negative. You should expect to be reimbursed under this circumstance.