Wiki Two questions on antepartum visit

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MnTwins29

MnTwins29

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One - forgive me if this is a stupid question, but can V22.2 be used as the first listed dx for an antepartum visit? I would not think so, but I have a doctor who consistently uses it.

Two - I had one record with documentation stating the complaint of pelvic pain was not OB-related, but no mention of this being an antepartum visit. However, there was no E/M assigned and it was being treated as a pre-natal visit as no CPT was assigned, the primary dx was V22.1 and no pelvic pain coded as a secondary dx. Something seems amiss, but for a rookie OB/GYN auditor, I wanted to ask the experts here.

Thank you!
 
1. It's better to use a V22.0 or V22.1, whichever is appropriate, but the V22.2 will work if you have no other choice. Depending on your visit situation, if other problems were addressed at TOS, you would probably use the other dx as primary & list the V22.2 later in your order. I'm assuming here that you're billing outside the global OB care codes for whatever reason. If the viisit occurs during the normal OB care, then the global code applies and choosing the correct V22.x code is an internal thing and isn't being billed to any carrier at this point. My OB docs always circle the V22.2 on their encounter forms. It's a lazy, quick dx to use but won't matter until delivery anyway, so it's not a big deal.

2. Not quite sure what you're asking here. Are you asking if the visit should have been billed separate from the global OB care? It's sounds like that was a possibility, but more info is needed--was the visit recorded on the prenatal visit sheet? Did the visit for pelvic pain occur during a regularly scheduled OB visit? If the answer is yes to both those questions, then the provider may have felt the visit was part of the global OB care. Getting paid for visits over and above the normal antepartum care is largely dependent on the insurance carrier rules, too.

I hope that info helps a little.

Becky, CPC
 
For antepartum codes use V22.0 for first pregnancy only; use V22.1 for all other pregnancies. If patient is seen for a problem visit not related to the pregnancy, e.g.
URI, you need to bill an E/M level and dx, plus V22.2.
 
Thanks!

Thanks for the responses. Becky, for clarification - on #1, this was a global OB visit, hence why I thought the first listed dx HAD to be V22.1 (not her first pregnancy), not V22.2. On #2, the documentation is not clear if the visit was a planned global OB visit or not. The chart note is listed in chron. order between two other OB visits, but the note itself only concentrates on the pain. No mention if this was scheduled and "oh, by the way" the patient is in pain, or if she came in for the pain only. I believe it was scheduled as a regular visit, but the note is very vague.
 
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If she came in for Pain even if its not her routine Scheduled day,
V22.2 can only be used if he stateds Pain is Incidental too Pregnancy.

I personaly would have coded it 648.93 & the Pain Code or site of Pain.
 
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