Ob-Gyn Coding Alert

Question: We have a patient pregnant with twins whose BP readings at her second prenatal visit were very high. The physician wanted the patient to come in every two weeks for a simple nurse BP check to have her pressure monitored. Half of the readings were high and the others normal. Should I bill the insurance for the nurse’s visits done outside of her antepartum schedule?

Vermont Subscriber

Answer: You can try, but you will likely be unsuccessful. You will be stuck with a 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) each time. Instead, you should wait until the end of the pregnancy to see if this condition worsened and allows you to add a modifier 22 (Increased procedural service) to the global service. The service you described is not really an MD evaluation, but simply getting a BP reading. As they say, “some are easy, some are hard.”