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Re: Hormone-Taking Is Linked to DementiaFrom: William McIntosh (williammcintosh@msn.com)Wed May 28 14:40:44 2003
I have a coding question for all you wise and generous colleagues out there. First, to set the stage: My wife and I are 2 out of 4 OB/GYNS in a 40 doc multispeciality group in Clarksville, TN. Virtually all OB is covered by global billing, and so it matters little how individual visits are coded as for the most part, but this is a military community (Ft Campbell, home of 101st Air Assault Division, 5th Special Forces Group, and more helicopters that any other place on earth) and we have a significant incidence of young women from elsewhere getting pregnant by a soldier, and then returning home after one or two OB visits, leaving us to bill for something less than a global fee. We are having a argument, with the docs on one side, and the professional coder in charge of our billing dept on the other about what constitutes a New OB Visit. When a patient calls the office to initiate OB care, she is given 2 appointments. The first should be within 1 week and is with each individual doctor's personal nurse. Pregnancy is confirmed, the ACOG prenatal chart is completed, the patient given generic dietary and activity counseling, prenatal vitamin samples are provided, lab work and so forth. She does not see the physician at all during that visit. The second appointment is with the doc, always within 2 weeks of the first call, and one week of the nurse visit. The doc has a counseling session with the patient (and partner if available), performs the physical exam, and does a dating U/S if past 10 weeks (we know we are not going to get paid for that one). Our groupwide coder has been using that nurse visit as the New OB visit (NOB), and the initial physician visit as the first of many ROB. It doesn't really matter if the patient has more than 3 ob visits,as it all gets covered by a global fee for prenatal care, but we have a small albeit steady rate of patients that leave after a visit or two and need to be billed out. It seems wrong to the docs in the OB dept to code that first nurse visit as a NOB visit if we end up having to bill it separately from a global fee, but our groupwide coder insists that this the way it should be done. We would like your opinion as to whether the nurse visit should indeed be coded as the one and only NOB, and if it should not, how can and should it be coded? William D McIntosh MD FACOG Clarksville, TN
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