Ob-Gyn Coding Alert

Hint: You must code what you know at the end of the visit Coding for the clinical diagnosis of a pregnancy can be complex when you have to decide between annual visits and nonscheduled exams. Take this six-question challenge, and see whether you-ve got when to begin your ob records down pat.
 
Key: When you-re trying to decide whether to begin the ob record, examine these three scenarios: (1) if a patient's annual visit leads to a diagnosis of her pregnancy, (2) if she arrives knowing she is pregnant, or (3) if the ob-gyn eliminates other possible diagnoses. Analyze These Annual Visit Questions Question 1: The ob-gyn diagnoses pregnancy during a patient's annual exam. Should you begin the ob record at this visit?
 
Answer 1: No. You should not begin the ob record until the next visit. Otherwise, carriers will consider the whole visit part of the global ob service (59400, 59510, 59610, 59618). Rationale: -The reason for the visit is the -annual exam,- and incidentally the ob-gyn learns the patient is pregnant during the visit,- says Shari Kheul, CCS-P, coding and reimbursement specialist at Women's Health Services in Clinton, Iowa.
 
Remember: If the ob-gyn diagnoses pregnancy (V72.42, Pregnancy examination or test, positive result) 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).
 
Rule: 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, but you do not have to use codes V22.0-V22.1 (Supervision of normal pregnancy) because the ob-gyn is not supervising the pregnancy at this visit. Also, you have the option of using V22.2 (Pregnant state, incidental). In general, V72.42 qualifies the pregnancy test as an incidental finding. Question 2: The patient comes in for her annual examination, already knowing she is pregnant. Should you begin the ob record at this visit?
 
Answer 2: No. -Again, the patient has come in for an annual exam, not a prenatal visit. Therefore, the pregnancy would be incidental to the well-woman code,- says Jennifer Ohmart, CAP, medical, claims and insurance specialist at Billing Bee in Lakewood, Calif.
 
In other words, you should not begin the ob record until the patient schedules a full visit with the ob-gyn or certified nurse midwife (CNM) for the initial obstetric exam and counseling. All visits, including the initial encounter with the physician or the CNM, count toward the total for global care, which generally includes 13 outpatient antepartum visits.
 
You will code the annual exam as you normally [...]