Wiki Auditing prenatal visits

[seank138]

Good morning,

I have recently begun to audit charts for prenatal visits. Does anyone have any current information/tools on auditing/documentation guidelines for the OB prenatal record? I am very familiar with with the normal E/M guidelines pertaining to office visits and preventive visits, but I haven't found anything that describes a prenatal visit in more detail.

Any information would be appreciated.

Thank you

 

[ahguzman]

Refer to ACOG's website and their flowsheet for pertinent info covered per trimester. Also, be especially mindful of your local Medicaid guidelines; typically they have their own billing parameters such as education must be provided or certain referrals must be made...

I also came across info pertaining to MDM/DX mngmt leveling in the COBGC study guide recently that states any work up (labs, etc) in which results are received during the visit should not be counted as additional work-up.

Hope this helps.

AHG
CPC, CPMA, CGSC