Ob-Gyn Coding Alert

Question: When a patient comes in for her first obstetrical visit, but she is also due for her yearly exam and Pap smear, is it appropriate to bill the visit as a well-woman exam, and bill separately from the ob package?

Ann Friday, RN
Midland, Texas

Answer: The visit at which you initiate the ob record is the start of the global period, and it would not be appropriate for you to bill a preventive medicine visit on the same day as the initial ob history and physical (H&P) examination. If the patient is seen for her comprehensive annual exam and at that visit the physician diagnoses pregnancy, you would code the service using the preventive medicine codes (99381-99397) applicable to her age and status as a new or established patient to your practice.

The physicians documentation in this instance must show, however, that a separate initial pregnancy history and physical was performed at the next visit (the patients first ob visit). The annual exam cannot be substituted for the ob H&P. This very clearly would be construed as double billing for the same service, and would also demonstrate that the ob record was initiated at the first visit.