Wiki Postpartum Visit or Office Visit

[LindsayC]

I have a couple providers who circle 99212-99213 for anything after 6 weeks when the patient comes in to restart birth control and have a pelvic exam.

I don't feel like this is right just because it's outside the 6 week mark. They circle V72.31, but they aren't doing a pap, they are only doing a pelvic exam/making sure everything looks OK for the patient. They ALSO will circle V25.09 (Family planning) or V25.41 (bcp - repeat).

Any input on how to explain this to the physician would be appreciated. Also, if I am wrong in thinking it should be included in the global, please let me know as well.

Thanks in advance...

 

[mitchellde]

Again it will depend on why this visit is scheduled for this timeframe. If it is due to scheduling difficulties then it is global, if this is when the office scheduled it it then it is part of global. If the payient did not bother to schedule a visit and this is when the patient chose to come in then I agree that it is an office visit. if a pelvic exam is performed with the breast exam then a V72.31 is correct.

 

[cghanbari]

Again it will depend on why this visit is scheduled for this timeframe. If it is due to scheduling difficulties then it is global, if this is when the office scheduled it it then it is part of global. If the payient did not bother to schedule a visit and this is when the patient chose to come in then I agree that it is an office visit. if a pelvic exam is performed with the breast exam then a V72.31 is correct.

What if their yearly was right before their pregnancy. Would you get paid if you use v72.31? Because that would not be 1 year. We have pts come back at after 6 weeks and ask for birth control and we bill EM and for contraception

. I am curious to know if other states have the same rule as we do in Texas. For Medicaid pts we can only bill a delivery code 59409 or 59514 and we have to bill the postpartum separate, but it must be 45-60 days

 

[gena379]

here- contraceptive managment is part of postpartum and included in teh global or postpartum charge. we dont bill a separate e/m just because they asked for BC. most insurance OB policies state that BC is included. The intent of the visit is postpartum. If patient came in at 8 weeks- i suppose that technically they are out of PP period and you coudl bill e/m... but is that really ethical? If you billed global OB then that means you already got paid for PP care... so if you think it's okay to bill e/m for an ov after 6 weeks then I would think you should have to re-bill the delivery to 59409/59514 so you are not getting paid twice for 1 visit.