Take this four part challenge to find out where you stand.
If your ob-gyn simply confirms a patient's pregnancy during an office visit, you will be able to report V72.42 (Pregnancy, confirmed). But when should you begin the ob record? Check your ob record skills with this four part challenge.
Scenario 1: The ob-gyn sees a patient who knows that she's pregnant via a positive home pregnancy test and simply "confirms the confirmation." When should you begin the ob record?
The key: At the next visit.
If the ob-gyn carried out only the urine pregnancy test, you would report 81025 (Urine pregnancy test, by visual color comparison methods) or possibly a low-level E/M service if there was some discussion about her health. Go for V72.42 (Pregnancy examination or test, positive result). You'll make use of this code when your ob-gyn simply tests to see if the patient is pregnant. This code will go on both the E/M code and the urine test, as you will be coding for what you know at the end of the visit. You will not require any other V codes.
Scenario 2: A patient comes in for an annual check-up and the ob-gyn diagnoses pregnancy. When should you begin the ob record?
Answer: At the next visit.
If you began the ob record during the annual exam visit, most carriers will consider the annual exam part of the global ob service. You cannot bill the global service until delivery, but you should inform the insurance company about the pregnancy. Remember to code any complaints, such as malaise, general fatigue, spotting, nausea, vomiting, pelvic pain, etc., that the patient reports of. You can report 99384-99386 for new patient or 99394-99396 for established patients.
Rule of Thumb: You shouldn't initiate the global care until you know that the patient wants her pregnancy to continue.
Scenario 3: A patient sees your ob-gyn after her family physician discovered that she's pregnant and wants to have her ob care with your practice. She has been under your practice since the last 12 months. When would you begin the ob record?
Answer: During this visit.
As some other physician made the diagnosis, your ob-gyn probably wouldn't need to "confirm the confirmation." Hence, he would begin the ob record, which means this service is part of the global ob package.
Tip: Some practices confirm intrauterine viability before they begin the barrage of ob coordination.
What's included: The ob coordination is lengthy, usually lasting about 30 minutes, and involves going over procedure guidelines, including a timetable of when to do lab tests, pelvic exams, amniocenteses, etc. The ob-gyn will usually provide vitamins and iron supplements and discuss when to call him.
Scenario 4: Your practice scheduled an initial ob appointment for a pregnant patient (who confirmed her pregnancy at home), but she can't wait to have some of her queries answered. She wants to come in earlier for counseling. The ob-gyn would perform no initial visit or ob panel blood work during this visit. When should you start the ob record?
Answer: This scenario could go either way.
Normally, carriers consider all counseling related to a pregnancy included in the global ob service. If the patient had significant health reasons to warrant counseling, you would wrap this visit into the global care of the patient. However, you'd report an E/M code such as 99201-99205 for a new patient, based on the time the ob-gyn spent with her, if you want to report this separately. The ob-gyn must document the duration of the counseling visit. The ob-gyn might ask,"Does the patient intend to keep her pregnancy? Are there extenuating circumstances about high-risk situations, such as drug abuse, need for genetic counseling, or current high-risk medications?"
If the patient is established, you'd report an established patient E/M visit (99211-99215). If a nurse who was not a certified nurse midwife or a nurse practitioner saw the patient, you must use 99211 for the encounter. As for a diagnosis code, you might try V65.40 (Counseling NOS) or V65.49 (Other specified counseling), but carriers do not usually allow you to use these codes as the primary diagnosis. Also, if the ob-gyn discusses genetics with the patient, you can use V26.3 (Genetic counseling and testing) instead.
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