Ob-Gyn Coding Alert

Question: The patient comes for a routine prenatal visit and has a yeast infection. Can we bill for a visit outside of the global code, or is that considered part of the global care?


South Carolina Subscriber


Answer: You can try to bill for it, but count only those things not related to the routine prenatal care in deciding the level of service. This will probably mean that for a straightforward infection with simple treatment you might find only a level-two service (99212, Office or other outpatient visit ...) documented for this infection.

However, many payers are looking for a diagnosis outside of the obstetric complications chapter before they will consider this service -unrelated- to pregnancy. So you must be sure that the physician also documents that the yeast infection is 1) incidental to pregnancy or 2) is not complicating the pregnancy if you want to report 112.1 (Candidiasis; of vulva and vagina) as the primary diagnosis.

If he does not do this, you will have to use a code that represents a complication of pregnancy (for instance, 646.83, Other specified complications of pregnancy; antepartum condition or complication, plus 112.1), which might result in no extra payment. Why: Many payers will pay for visits for unrelated conditions but not for complications until the patient has had 13 antepartum visits.