Wiki Confirmation of pregnancy office visit

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AMBERRUIZ

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Good afternoon,

Our office currently bills an new/est office visit and a transvaginal/abdominal gyn ultrasound to confirm a patients pregnancy separate from the global billing. We have always been paid for these visits as they are considered gyn since pregnancy has yet to be confirmed and are billed out with abscence of menstration and positive pregnancy. All of the insurance companies that we bill to are paying this visit with the exception of one health plan that now has it as a health plan edit that it is included in the global package. They state that we are one of the only offices billing this and no matter what the coding practices say, they state it is not separately billable. We are located in Portland, Oregon. Can anyone else in our state or outside, tell us if they too bill for this visit?

Thank you!
 
Hi,

The provider's that I bill for also bill the pregnancy confirmation visit. Using the Dx code V72.42, we can bill a 99202 or 99203 only. AMA and ACOG has determined that these two office visits can be billed up to the 20th week. After that, an appropriate level initial OB visit should be billed (99204 or 99205 and must use a different Dx code). We have very good success at getting this visit paid with almost all insurance companies. My provider's are in California.

Hope this helps.
 
Thanks! We have billed this way for years and are our providers are disputing with the medical directors at a certain insurance company over this being separate from the global package. I am hoping the other insurance companies do not follow suit! =)
 
you say you use the code absence of menstruation (626.0 I presume) This code is incorrect if the reason for the visit is to confirm pregnancy. A code cannot be use out of context, you must apply the category description as well as the chapter description. 626 is the category for Disorders of Menstruation and other abnormal bleeding from female genital tract. All codes in this category must fit this description. the definition of 626.0 is this is either primary or secondary.. primary is a total absence of periods prior to the age of 16 and secondary is an absence of 6 months or greater. The category does not fit for a patient that is coming to check for pregnancy, this is not a disorder of menstruation nor do they meet the criteria for primary or secondary. The Chapter is disorders of the genitourinary system. These patients are normal and have no medical problem therefore the correct and only code for a patient to present to confirm pregnancy is the V72.4x code.
It is unusual to confirm pregnancy with a transvaginal ultrasound, is there any reason why you do not use the urine and or blood test for this?
 
More clarification needed to code corretly!

This whole initial visit thing has me confused on how my doctors should bill the initial visit - can anyone give a straight forward way to code these? Our patients come in either for a first visit - usually prior to 8 weeks for a confirmatory visit. These are usually billed at a 99202 or 99212-99213, (depending on what the doctor did), along with the pregnancy test and then are given an appointment for their first PNV which begins the global period. However, some patients, those usually at 8 weeks or more come in and have a confirmatory pregnancy test and then the OB record is started on the same date. I have been told if they are new patients (to the practice) the doctors should bill the appropriate new pt E/M - which usually is only a 99202 due to lack of an HPI in the documentation (although the rest of the chart documentation could support at least a 99204). I have also been told that if this is an established patient and the OB record has been started, then this visit would be considered part of the global OB package and we only bill for the pregnancy test. The doctors also use the ammenorrhea diagnosis too for the E/M and use the V72.42 for the pregnancy test - which code should they be using for the E/M charge?

I am responsible for teaching the doctors the correct way to code their office visits and I am not sure if this is correct - and if not, I would like to know exactly what is the correct way to bill these initial OB visits!

Thanks for any help I get to understand the correct way to bill these visits!
 
Im not sure how far back you can get a bulletin, but ACOG put out a wonderful one explaining how to report the confirmation of a pregnancy visit (2010). If you are not able to get it, I can fax it to you...... I hope this helps
 
jdibble said:
This whole initial visit thing has me confused on how my doctors should bill the initial visit - can anyone give a straight forward way to code these? Our patients come in either for a first visit - usually prior to 8 weeks for a confirmatory visit. These are usually billed at a 99202 or 99212-99213, (depending on what the doctor did), along with the pregnancy test and then are given an appointment for their first PNV which begins the global period. However, some patients, those usually at 8 weeks or more come in and have a confirmatory pregnancy test and then the OB record is started on the same date. I have been told if they are new patients (to the practice) the doctors should bill the appropriate new pt E/M - which usually is only a 99202 due to lack of an HPI in the documentation (although the rest of the chart documentation could support at least a 99204). I have also been told that if this is an established patient and the OB record has been started, then this visit would be considered part of the global OB package and we only bill for the pregnancy test. The doctors also use the ammenorrhea diagnosis too for the E/M and use the V72.42 for the pregnancy test - which code should they be using for the E/M charge?

I am responsible for teaching the doctors the correct way to code their office visits and I am not sure if this is correct - and if not, I would like to know exactly what is the correct way to bill these initial OB visits!

Thanks for any help I get to understand the correct way to bill these visits!
Click to expand...
the V72.4x code works for the E&M as well as the test , the code states "examination or test". The 626.x codes are incorrect for these encounters by code definition
 
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