Ob-Gyn Coding Alert

Postpartum checks are a normal part of global obstetrical care, but often these visits are more complicated than what is considered routine, and in such cases coders may miss opportunities for additional reimbursement.
 
During a routine postpartum check, the physician performs a history and physical and interviews the patient to determine her overall postpartum status. This discussion frequently covers contraception, breast-feeding or other questions the patient might have related to the aftermath of her pregnancy. Although it is the equivalent of an E/M visit, the postpartum check is included in the global package.
 
According to the American College of Obstetricians and Gynecologists' (ACOG) Ob/Gyn Coding Manual, postpartum services include "a recovery room visit, uncomplicated inpatient hospital postpartum visits" and, most important, "uncomplicated outpatient visits until six weeks postpartum."
 
Alternatively, those services not included in routine postpartum care are "management of inpatient or outpatient medical problems not related to the pregnancy, management of inpatient or outpatient medical problems or complications related to the pregnancy, management of surgical problems arising in the postpartum period and tubal ligation."
 
Given these guidelines, coders must determine with their physicians what is and isn't routine for postpartum care. Once you determine that a visit was not routine, you must choose the right code and/or modifier to bill the service. "When there is clearly a complication or problem in the patient that's outside the realm of global ob care, that's fairly straightforward from a coding perspective," says Melanie Witt, RN, CPC, MA, an independent coding educator and ob/gyn coding expert based in Fredericksburg, Va. These might include a case of influenza, upper respiratory infection, etc. "But there are always gray areas that make coding decisions a bit more challenging."
Postpartum Case Study  
A patient who had a routine pregnancy and delivery reports for her postpartum checkup. The ob/gyn documents in his or her notes that the patient is breast-feeding, has not had a period yet and has a good energy level. The physician also notes the topics of their discussion:
 
Vaginal dryness. The physician mentioned the possibility of vaginal dryness while breast-feeding, and the patient said she would tell the doctor if it becomes a problem.
 
Contraception. The patient was scheduled to resume oral contraceptives and was told that she might have a long delay in menstruation as long as she continues to breast-feed.
  Breast mass. The patient had a breast mass that the physician suspected was a blocked duct. The ob/gyn advised her to check it monthly and return in three months for a recheck.

Hyperthyroidism. The patient had undergone radioablation for Grave's disease. The physician ordered a thyroid stimulating hormone (TSH) test and said he or she will contact the patient [...]