OB: coding

From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Wed May 28 21:36:34 2003

Bill:

If I get this right, you are trying to code for the 3 or so visits that are not part of global Ob care, as these are transient patients, so to speak.

If someone has a partial number of Ob visits (and I don't have a CPT 2003 handy at home, but I do have a spreadsheet with our prices), then there are codes for antenatal visits, like 4 to 7, or 7+, I belive.

It seems to me that you should code as follows:

Nurse visit--new or established patient, brief E/M code. That is because that's all you can bill for a nurse visit. If blood is drawn, and you don't bill for the lab test, bill for the venipuncture, too. I would think the transients would be new, not old, and I believe that the lowest level E/M for a new patient is a higher level of service than the lowest for an old patient (because you have to establish a history). I bet the codes are 99202 (new) and 99212 (established).

Doctor Visit--since you do a physical, and history (well, it is reveiwed), if it qualifies for a comprehensive examination (it should), use 99215, the E/M for established (they won't be new, since they've seen the nurse) comprehensive. If you do an ultrasound, document it and bill it.

The diagnosis code for both should be amenorrhea.

I would expect that these should be paid, just as similar services would be paid for another diagnosis.

Have you tried this?

Garry

At Wed, 28 May 2003, William McIntosh wrote: >
>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

--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA



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