Primary Care Coding Alert
Avoid Double-Billing by Dissecting This Same-Office Scenario
Question: My office has primary care physicians (PCPs) and ob-gyn doctors. We have a patient that saw her PCP on 12/1/23 and the PCP noted normal pregnancy, except for hypertension, and calf pain. However, the patient didn’t see the ob-gyn doctor in our group until 12/14/23 to confirm her pregnancy. Then, the first OB visit/start of prenatal flow sheet is set for 12/20/23. Can we use the pregnancy O codes on the PCP visit on 12/1/23 even though we are going to bill out the confirmation code Z32.01 on 12/14/23 with the specialist? Maryland Subscriber Answer: The PCP diagnosis will not be an O code since the PCP is not addressing pregnancy issues at the encounter. If the PCP diagnoses pregnancy based on a test done in the office, then Z32.01 (Encounter for pregnancy test, result positive) may be reported. However, if she came into the PCP with a home pregnancy test and the PCP did not do any confirmation test, the PCP will bill only report for the care given based on the presenting problem (such as calf pain, coded to M79.66- (Pain in lower leg) or hypertension, likely coded to I10 (Essential (primary) hypertension) You can then bill the confirmation test from 12/14 and use Z32.01. 
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