Primary Care Coding Alert

When your FP simply confirms a patient's pregnancy during an office visit, automatically assuming that you should begin the global record could sacrifice $40-$60 per visit. Test your maternity record skills with the following three questions.

Question 1: The FP sees a patient who knows that she's pregnant via a positive home pregnancy test and simply "confirms the confirmation." When should you start the maternity care record?

Question 2: A patient comes in for an annual exam, and the FP diagnoses pregnancy. When should you start the maternity care record?

Question 3: Your practice scheduled an initial maternity care appointment for a pregnant patient (who confirmed her pregnancy at home), but she can't wait to have some of her questions answered. She wants to come in earlier for counseling. The FP would perform no initial visit or obstetric panel blood work during this visit. When should you start the maternity care record?

Answer 1: Start the maternity care record at the next visit, says Angela Maddox, office manager of Pathway Women's Health PLC in Battle Creek, Mich.

If the FP performed only the urine pregnancy test, you-d report 81025 (Urine pregnancy test, by visual color comparison methods) and possibly a low-level E/M service (such as 99201-99202 for new patients or 99211-99212 for established patients) if some discussion about her health took place that consumed more than half of the physician's face-to-face time with the patient.

You will use V72.42 (Pregnancy examination or test, positive result) when your FP simply tests to see if the patient is pregnant. Because you-ll be coding for what you know at the end of the visit, this code will go on both the E/M code and the urine test.

News: United Healthcare (UHC) has announced that it will revise its payment policy for this situation. Effective in the second quarter of 2008, UHC will pay separately for this E/M visit prior to the maternity care record initiation -- but only when you link V72.42 to the office E/M CPT code. "This is a welcome change for us," says Rachel Hollis, CPC, billing manager for Galisteo Ob-Gyn Associates in Santa Fe, N.M. "This will help eliminate confusion between the beginning of maternity care management and the confirmation of the pregnancy." For more information, see UHC's December Network Bulletin or contact your provider representative.

Answer 2: In this scenario, you should start the maternity care record at the next visit, says Pat Larabee, CPC, CCP-P, coding specialist at InterMed in South Portland, Maine.

"The patient was here for her annual exam, not to start care for her pregnancy," Maddox agrees.

If you began the maternity care record during the annual exam visit, most carriers will consider the annual exam part of the global maternity service. You cannot bill the global service until delivery, but you should inform the insurance company of the pregnancy.

Rule of thumb: Until you know that the patient wants her pregnancy to continue, you shouldn't initiate the global care.

Answer 3: "This is a tough one," Larrabee says.

This scenario could go either way.

Normally, carriers consider all counseling related to a pregnancy included in the global maternity service -- whether the physician sees the patient or not. If the FP or a nonphysician provider (NPP), such as a nurse practitioner, counsels the patient regarding normal pregnancy, you should wrap this visit into the patient's global care package.

Some payers allow separate reporting. In this case, select the appropriate level office visit code based on the encounter's total time, provided the counseling comprises the majority of the visit's total face-to-face time. The physician or NPP must document the duration of the counseling visit and summarize the content -- for instance, the patient's intentions for the fetus, high-risk situations such as drug abuse, need for genetic counseling, or current high-risk medications.

Be careful: If a nurse who was not a nurse practitioner saw the patient, you must use 99211 for the encounter.

For a diagnosis code, you might try V65.49 (Other specified counseling), but carriers don't usually allow you to use this code as the primary diagnosis. Also, under ICD-9-CM rules, you would need to use V22.0-V22.1 (Supervision of normal pregnancy ...) as the primary diagnosis because you are providing a service directly related to the pregnancy.

Also, if the provider discusses genetics with the patient, you can instead use V26.3X (Genetic counseling and testing).