Ob-Gyn Coding Alert

Question: I attended The Coding Institute's Ob-gyn Coding Conference in Naples, Fla., in June of this year. I realize we can bill outside of the global ob package for complications. But would I use an E/M code for gestational diabetes, hypertension, bleeding and hyperemesis outside of the global or only if the patient exceeds 13 visits? I would then use modifier 22, correct?


Arizona Subscriber

Answer: You have two options: 

First, you could try billing every visit after the 13th that involves the management of the problem (such as gestational diabetes or bleeding) as an E/M service with the appropriate code for the complication.

Watch out: Your physician must have documented this in a manner that allows you to translate his wording unequivocally into an E/M service. Notes on the flow sheet are usually not adequate if you expect to get paid. Also, do not count any of the routine antepartum care when selecting the level of service. 

If the payer rejects this form of billing, your only other choice is to add modifier 22 (Unusual procedural services) to the global code after delivery.

Caution: Again, your submitted documentation should include the number of visits that exceeded the norm, the reason for the visits, and the service levels these would represent (and have the backup medical record handy to prove your claim). Some will pay, while others will not.