Ob-Gyn Coding Alert

Question:

California Subscriber

There are really two issues here:

First, you can only bill extra visits if the payer allows it, and generally the payer will not take kindly to you billing them for each visit of a high risk pregnancy when you should be billing globally (such as, 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). Being high risk is not the same as having a complicated pregnancy with intervention and additional management required.  Most payers expect that you will provide up to 13 antepartum visits for global care at the frequency indicated in CPT^®.

If the physician is managing a complicated pregnancy, some payers will recognize care for that complication outside of global care " but you have to know your payer policy to be sure. When diagnosing a complication for the first time, you should probably submit that E/M (such as 99214, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family) to the payer to avoid timely filing issues (if you have this written into your contract). If and when you get a denial, you can then appeal at the end of the pregnancy if warranted.

Second, every provider should level every ob visit whether they are billing for them or not. This allows you to account for productivity of the various providers seeing the patient during her pregnancy and also lets you bill out extra visits at the end of the pregnancy without going back to the provider to pick the level of service. You can track these non-billable antepartum visits by placing a no-pay modifier on them, so they don't get sent out to the payer until you know where you stand after delivery.