When your ob-gyn sees a patient for a nonannual examination visit and the reports says that she is pregnant, what code should you report? This is the time when you need to adhere to the golden rule: code what you know at the end of the visit.
When Nonscheduled Visit Determines Pregnancy
Follow these three scenarios, and you’ll know when to start the global ob record.
Scenario 1: The patient sees her ob-gyn for abdominal cramping, sweating, having missed a period, or other possible symptoms. These complaints prompt the ob-gyn to order a pregnancy test (like 81025, Urine pregnancy test, by visual color comparison methods). He learns from the results that she is pregnant.
|Ob-Gyn Coding Alert Your practical adviser for ethically optimizing coding, reimbursement, and efficiency for Ob-Gyn practices. Click here to buy the monthly Ob-Gyn Coding Alert.|
Solution: You should report an E/M service (for example, 99212, Office or other outpatient visit, established patient, problem-focused history and examination, straightforward medical decision-making) because the symptoms are related to a problem that turned out to be pregnancy. If the ob-gyn evaluated other possible problems (which eventually revealed the pregnancy), you should report this service outside the global ob package.
You should still report the pregnancy code (V72.42, Pregnancy examination or test, positive result) by attaching it to the lab test for pregnancy, but make sure the claim clearly details that the ob-gyn did not see the patient for pregnancy but for other symptoms.
Scenario 2: If the patient comes in with complaints and thinks she might be pregnant (she has taken a home pregnancy test), the ob-gyn will determine whether these complaints relate to the pregnancy.
Solution: If these complaints do relate...
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers