When Does Global Maternal Care Begin?
Published on Mon Aug 30, 2004
Look at both annual and nonscheduled exams
Global maternal care depends on the method the ob-gyn uses to determine if a patient is pregnant, but coding for the clinical diagnosis of the pregnancy becomes complicated when you have to decide between annual visits and nonscheduled exams.
In the majority of circumstances, you should not begin counting antepartum visits for the global maternity codes (59400, 59510, 59610, 59618) until the next full visit, coding experts say.
When the Ob-Gyn Determines Pregnancy During Annual Exam Annual visits often lead to confusion when it comes to establishing a patient's pregnancy. You should choose from a range of different E/M codes according to three scenarios:
if a patient's annual visit leads to a diagnosis of her pregnancy,
if she arrives knowing that she is pregnant, or
if the ob-gyn eliminates other possible diagnoses. Scenario 1: If the ob-gyn diagnoses pregnancy (V22.0, Supervision of normal first pregnancy; V22.1, Supervision of other normal pregnancy; or V22.2, Pregnant state, incidental) during a patient's annual exam (99384-99386 for new patients, or 99394-99396 for established patients), you can still report the annual examination, as long as you link the pregnancy diagnosis to the diagnostic test (for instance, 81025, Urine pregnancy test, by visual color comparison methods).
However, you should not begin the ob record until the next visit. Otherwise, carriers will consider the whole visit part of the global ob service.
Keep in mind: You must report what you know at the end of any visit. If the ob-gyn knows the patient is pregnant, you must report the patient as pregnant and include the pregnancy diagnosis (V22.0-V22.2).
Scenario 2: The patient comes in for her annual examination, already knowing she is pregnant. You should code the visit as a low-level service (for example, 99212, Office or other outpatient visit, established patient, problem-focused history and examination, straightforward medical decision-making) to confirm her pregnancy (such as 81025). Remember to link the diagnosis (V22.0-V22.2) to the test.
After this visit, the patient will schedule a full visit with the ob-gyn. "The global care would begin at this first visit," says Lynn Anderanin, CPC, senior coding consultant for Health Info Services in Des Plaines, Ill. All visits, including the initial encounter with the physician, count toward the total for global care, which generally includes 13 outpatient antepartum visits.
Scenario 3: If the patient presents for her annual exam but has other complaints, and the ob-gyn then discovers pregnancy, the work involved in eliminating other possible diagnoses may constitute a higher-level E/M service (such as 99214, Office or other outpatient visit for an established patient ... 25 minutes face-to-face).
That work would not focus on or relate to the pregnancy, except to confirm it with a test (like 81025). Therefore, [...]
