59400, 99212, 99213: How to Add Complication Visits to the Global Ob Package

Posted on 14. Nov, 2010 by jennifer.godreau.

Hint: You can report complications before or after delivery.

You can receive increased reimbursement when your ob-gyn provides additional visits outside of the normal global ob package, but you’ll have to make sure you’ve coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding skills.

Insist on Perfect ICD-9s

You have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code, for example, to demonstrate the reason for the additional service. You can add this to the claim that includes the global service, or you can submit it as an additional claim.

Example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is seen in the office 19 times due to developing pre-eclampsia. After the delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family), while three of the visits have more extensive documentation that supports reporting 99213 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 15 minutes face-to-face with the patient and/or family).

In addition, after delivery, the patient experiences prolonged pain and irritation due to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. Finally, the ob-gyn rechecks the patient at her six weeks postpartum visit.

Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services, as well as the diagnoses that…

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Pregnancy Global Coding Guide: 59400, 59510, 59610 & 59618 Tips

Posted on 29. Jul, 2009 by .

Good news: You can report a higher-level (and higher-paying) E/M in this annual-visit situation.

Annual visits often lead to confusion when it comes to establishing a patient’s pregnancy. Take this 3-part challenge by deciding if the ob-gyn package begins based on these scenarios:

• a patient’s annual visit leads to a diagnosis of her pregnancy,

• she arrives knowing that she is pregnant, or

• the ob-gyn eliminates other possible diagnoses.

Hint: In the majority of circumstances, you should not begin counting antepartum visits for the global maternity codes (59400, 59510, 59610, 59618) until the next full visit, coding experts say.

AUDIO: The #1 mistake providers make when choosing the level of antepartum service. Melanie Witt shows you how to fix it for good.

Still Report Annual When Visit Leads to Pregnancy Dx

Scenario 1: If the ob-gyn diagnoses pregnancy (V72.42, Pregnancy examination or test, positive result) during a patient’s annual exam (99384-99386 for new patients, or 99394-99396 for established patients), you can still report the annual examination, as long as you link the pregnancy diagnosis to the diagnostic test (for instance, 81025, Urine pregnancy test, by visual color comparison methods).

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Bust These Delivery Coding Myths to Streamline Your Ob Claims

Posted on 21. Apr, 2009 by .

Warning: Ordering twin delivery codes incorrectly could cost you.

Focusing solely on global codes when your ob-gyn or hospital nursing staff performs a delivery will increase your chances of making a costly mistake. Sometimes extenuating circumstances require you to choose from itemized delivery codes — and use modifiers like 51, 59, and 22.

Ob-Gyn Coding Instruction that really delivers.

Face these five delivery myths and uncover the coding reality.

Myth #1: Out-of-Town Ob-Gyn Means You Code Global

Suppose your pregnant patient’s regular ob-gyn is out of town when the patient goes into labor. Your ob-gyn, who is not affiliated with the regular ob-gyn, performs a normal delivery. If you think this gives you leave to report a global ob code, then you’re setting up your claim for disaster.

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Global Ob Coding Checklist: More for Twin Deliveries?

Posted on 08. Apr, 2009 by .

Use your ICD-9 codes properly, and you give your OB global package claims some solid footing.

The following tips, provided by Laura Knight, CPC, project coordinator of medical services administration at Good Samaritan Community Healthcare in Puyallup, Wash., will ensure your global ob package success every time.

Put These ICD-9 Tips to Good Use

Item 1: Make sure you choose all ICD-9 selections for ob billing from the 640-677 range of ICD-9 diagnoses.

The OB specialty coding conference that ALWAYS DELIVERS. More details here.

Item 2: Always code to the highest specificity when you need to add a fifth digit to denote the episode of care (such as for complications mainly related to pregnancy, 651-659):

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