Wiki Family practice clinics and O codes

[kimberagame]

Hello!

I'm trying to figure out the best way to code this, and was hoping for other peoples' input. I work for a family practice clinic, and from time to time we get pregnant patients coming in to be seen regarding their pregnancy. For instance, right now we have a patient who is a few month in to her pregnancy and this is the first time she's seeking medical care for it. She was referred to an Ob/Gyn office, but for her visit with us, the most appropriate code would be an O code. Pregnancy is not incidental to the visit, so Z33.1 won't work. She's not there for a pregnancy test, so we can't use the Z32.0 codes. But when we use O codes, they get denied by insurance since, as I understand it, pregnancy care is paid as a lump sum after the fact.

Has anyone else been in this situation and found a way of getting paid for these visits?

Thanks!

 

[mitchellde]

If this is a supervision of pregnancy encounter with no other issues then it is a Z code not an O code. I have never had an issue with the Z34 codes for supervision or most of the codes for issues in pregnancy being paid for family practice. Perhaps it is your choice of O code or the sequence in the past that has been an issue. For instance if a pregnan patient comes to your office for asthma issues, you would use the O99.5-- Code first listed with a J45.-- code secondary, with the Z3A for the weeks of gestation next.