Ob-Gyn Coding Alert

The global ob package heads the list of the most frequently billed services in most ob/gyn practices, but many coders aren't clear on what is and isn't included in the package.

Specifically, coders want to know when global ob care starts and whether a patient's initial visit can be billed outside the package.

According to CPT 2002, four global codes describe routine obstetric scenarios resulting in delivery: 59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care. 59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care. 59610 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum car, after previous cesarean delivery. 59618 Routine obstetric care including antepartum care, cesarean delivery and postpartum care, following attempted vaginal delivery after previous cesarean delivery. In the chapter notes preceding the codes, CPT indicates that uncomplicated maternity cases include such services as "initial and subsequent history, physical examinations, recording of weight, blood pressure, fetal heart tones, routine chemical urinalysis, monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation and weekly visits until delivery." Coding the Initial Visit Depends on Diagnosis Despite CPT's description of included services, there is confusion about how to code the initial ob visit, says Michele Creswell, LPN, CPC, billing manager for the department of obstetrics and gynecology at the University of Nebraska Medical Center in Omaha. "I wonder how many practices are billing for the first ob visit and what diagnosis code they're using," she asks. The answer depends on when pregnancy is established. At the outset of global ob care, most physicians require a reliable pregnancy test prior to setting up the initial visit, which is usually in-depth and lasts about 40 minutes. This is the start, or the first visit, of the ob global package.

But many practices do not accept home pregnancy tests and require a test from the patient's primary care physician or another medical source. So, if the patient does not have reliable pregnancy-test results from another physician or clinic, many practices schedule an initial visit just for administering a pregnancy test, usually by urinalysis (81025, Urine pregnancy test, by visual color comparison methods). At this visit, the patient reports to the office and gives a urine sample. When the pregnancy is confirmed, the patient schedules a full visit with the physician, initiating her global care. All visits, including the initial encounter with the physician, are counted toward the total for global ob care, which is generally accepted as including 13 outpatient antepartum visits. ACOG Says Accept Home Pregnancy Tests If the patient presents with a positive home pregnancy test in other words, [...]