Ob-Gyn Coding Alert

You can report this service outside the global ob package.

If you took the three-question coding quiz on page 27, then you should have your answers ready. Check your solutions against our experts- to determine how well you know how to report global packages.

Answer 1: No, says Arlene J. Smith, CPC, insurance specialist at Tacoma Women's Specialists in Washington. If you-re reporting your physician visits this way, you-re incorrectly coding under everyone's rules. If you were to be audited, your payers would consider each and every one of these ob-gyn visits a part of the global, which means you can expect to give some refunds.

Let's say your nurse does a prenatal interview that lasts about an hour. She goes over risks, things to watch for, and what is normal, and orders prenatal labs, urine cultures, and glucola. In this case, you would not report any visit code since normal routine prenatal care was begun at that visit.

Rule of thumb: When you initiate the patient's antepartum record, then you-ll always include that visit as part of the global service. You may be able to report the first visit when the ob-gyn or nurse performs a pregnancy test outside of the global, but you should consider all other visits related to pregnancy a part of the global package.

"We don't require patients to come in for blood work to determine pregnancy. They usually take a home pregnancy test and then schedule the first visit as early as nine weeks, not earlier," says Kathleen Goodwin, CPC, coding coordinator at La Porte Regional Physicians Network in La Porte, Ind.

Answer 2: No.

First, you should know that amenorrhea, by clinical definition, means no menstrual periods for six months or no periods for three months with documented irregular periods. You shouldn't use this code at a visit in which the ob-gyn diagnoses pregnancy. Otherwise, you-d be giving the patient a disease condition.-

You should report V72.42 (Pregnancy examination or test, positive result). You will use this code when your ob-gyn simply tests to see whether the patient is pregnant, and the results are positive. You should link this diagnosis to both the E/M code and the urine test, because you-ll be coding for what you know at the end of the visit. You won't need any other V codes.

Red flag: "Never code to get paid. You should code for the accuracy of the diagnosis at the time of the visit," says Jennifer Ohmart, medical billing, coding, and insurance specialist at an ob-gyn practice in Englewood, Colo.

In other words, don't revert to a diagnosis simply because you know it will return reimbursement. That could set your practice up for charges of fraud and abuse.

Answer 3: No, Smith says. "If a patient is having problems beyond -services normally provided in uncomplicated maternity care,- according to CPT, then you can bill outside the global," Goodwin agrees.

The global ob package is designed to cover all prenatal care that is usual and customary. A threatened AB does not fit into the "usual and customary" category. This is an urgent care issue for the E/M of a difficulty in pregnancy. Therefore, you should report this visit outside of the global service with 640.03 (Threatened abortion; antepartum condition or complication) or 640.83 (Other specified hemorrhage in early pregnancy; antepartum condition or complication).

Tip: The American College of Obstetricians and Gynecologists (ACOG) recommends that your encounter for a problem be documented outside your ACOG flow sheet. You should specifically mention "complication" in a separate area of the chart, experts say.

Many payers may deny these services or want them reported at the end of the pregnancy (such as delivery or after). Some insurers may want you to use itemization to report them. Or they may just want you to append modifier 22 (Unusual procedural services), thus increasing the fee of the global, experts add. Query your payer to see which method it prefers.