Wiki OB/GYN coding - A patient came in for initial prenatal visit

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rbell125

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A patient came in for initial prenatal visit and all initial documentation was completed. The physician also added that patient needed annual GYN done and pap smear. The insurance pays for OB visits globally at end of pregnancy.
The physician codes
V22.0
V72.31

99213

My questions is, shouldn't the physician be billing a Preventive visit for the gyn annual as well? Should the 99213 be removed since OB visits are paid for globally at end of pregnancy?

Thank you for helping in advance : )
 
OB visit with an Annual on the same day

yes, the 99213 should be removed and replaced with a preventative visit. The ob appointment is global so it can't be charged at this visit but I would document this visit as the first ob visit. Our office uses the 0502F with a zero charge and does not let it go to insurance. This is a good way to keep up with the number of visits the patient has.
 
Pap and first prenatal visit

I do apologize, but I could not find any answers to my question and I had no where else to turn. I am wondering, when a patient comes in for her first prenatal visit and the provider also does a pap, is this included with the prenatal visit? This would be for Medicaid insurance coding the 99203 with the Q0091 code. Could anyone assist me with this please? Thank you,
 
Initial OB w/ Pap

lddavis said:
I do apologize, but I could not find any answers to my question and I had no where else to turn. I am wondering, when a patient comes in for her first prenatal visit and the provider also does a pap, is this included with the prenatal visit? This would be for Medicaid insurance coding the 99203 with the Q0091 code. Could anyone assist me with this please? Thank you,
Click to expand...

Hi there! So when the provider performs the first OB visit, it is a parallel intake to the GYN preventative. This initial intake (that runs the same extensive HPI (potentially), PFSH, and exam as a WWE) and the pap itself are all included in OB package. You would use your internal "dummy" code for the initial OB visit only.
Now, if there are additional concerns with the initial intake (any STD's, previous or current high risk, existing conditions, etc.), then it would be advisable to code an additional E/M visit for the work that is above and beyond only, with the mod 25 of course. Additionally, if there are any abnormalities with the pap, and another would have to be performed, then that can be coded with an E/M.
Please remember that Q0091 is a MEDICARE carve-out only code, and should not be used with any other primary payer.. It gets overlooked in payer's (specifically Medicaid's) database, in case Medicaid is secondary to Medicare. If it gets paid, it doesn't mean it's right.
Good luck!
Annie Daniel, CPC, CPMA, CEMC
 
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