Ob-Gyn Coding Alert

Question: My office has primary care physicians (PCPs) and ob-gyn doctors. We have a patient that saw her PCP on 8/2/22 and PCP noted normal pregnancy, except for hypertension, and then she also discussed calf pain. However, the patient doesn’t see the ob-gyn doctor in our group until 8/16/22 to confirm her pregnancy. Then, the first ob visit/start of prenatal flow sheet is set for 8/30/22.

Can we use the pregnancy O codes on the PCP visit on 8/2/22, even though we are going to bill out the confirmation code Z32.01 on 8/16/22 with the specialist?

South Carolina Subscriber

Answer: The PCP diagnosis will be Z32.01 (Encounter for pregnancy test, result positive), not an O code since the PCP is not providing ob care. If the PCP has already diagnosed pregnancy, you should not be doing a repeat confirmation test and the visit on 8/16 is not medically indicated.

If she came in to the PCP with a home pregnancy test and the PCP did not do any confirmation test, the PCP will bill only for the care given based on the presenting problem (such as calf pain, M79.66- or hypertension, I10) with an optional secondary diagnosis of pregnancy not confirmed (Z32.00) You can then perform a confirmation test on 8/16 and use the Z32.01 code.