Coding OB Visits Objectives Accurately code Prenatal Visits

Coding OB Visits

Objectives Accurately code: -Prenatal Visits (OB Checks) -Office visits by prenatal patients for ‘other than’ prenatal care/check ups -Prenatal visits with ‘other’ problems addressed -Common complicated OB Diagnosis, V codes and CPT codes

Coding OB Office Visits What was involved: OB check only Issues only OB check and issues Use of: ICD-9 Codes CPT Codes E & M Codes

OB Check Prenatal visits/OB Checks = “Bundled” Each visit does not generate a separate Office Visit code unless issue other than OB Check is addressed and supported by documentation. MHS Coding Guidance Version 2. 0 Specialty Coding Section 6. 10 Obstetric Services Pages 6 -38 to 6 -47

ICD-9 Codes V 22. 0 - supervision of normal first pregnancy V 22. 1 - supervision of other normal pregnancy V 22. 2 - pregnant state, incidental V 23. 8 Other High Risk pregnancy V 23. 81 – elderly primigravida V 23. 82 – elderly multigravida 640 -649 Complications of Pregnancy

Complications of Pregnancy ICD-9 Code: 640 – 649 Series Need 5 th digit to identify episode of care: 3 – antepartum condition or complication 0 – unspecified or not applicable 1 – delivered, w/wo mention of antepartum condition 2 – delivered, with mention of postpartum complication 4 – postpartum condition or complication

Examples 640. 03 - Threatened AB 642. 03 – Benign essential hypertension complicating pregnancy, etc. 643. 03 – Mild hyperemesis gravidarum 648. 83 – Abnormal glucose tolerance – Gestational diabetes 649. 33 – Coagulation defects complicating pregnancy, etc. 649. 63 – Uterine size date discrepancy

OB Visit CPT Codes CPT Code: Use these CPT codes with ICD-9 code and E & M code whenever OB checks are performed during the office visit whether or not issues/complications are addressed: 0500 F – First OB Visit 0502 F – Subsequent OB checks 0503 F – Post Partum Visit

E & M Code 99499 Use whenever OB check only is done. Use with: V 22. 0/V 22. 1 for ICD-9 (diagnosis) 0500 F/0502 F/0503 F for CPT codes

E & M Code 99212, 99213, 99214, or 99215 Use Level II – V established (or new if appropriate – 99201, 99202, 99203, or 99204) office visit code when addressing issues/problems for pregnant patient whether or not OB check is done.

Problem Only ICD-9 Diagnosis for the problem (asthma, sprained ankle, URI, etc. ) and V 22. 2 – incidental pregnancy to indicate this patient is pregnant or Complicated OB diagnosis series 640 - 649

Problem + OB Check ICD-9 Diagnosis for the problem plus V 22. 0/V 22. 1 if normal pregnancy. If complicated pregnancy, do not use V 22. 0/V 22. 1 but use appropriate complications of pregnancy ICD 9 Code (640 – 649 series). CPT Code 0500 F/0502 F/0503 F – appropriate for visit

When using Office Visit Code Documentation must exist to support the level of visit you are coding: History of Present Illness Physical Exam Medical Decision Making

Summary Pregnant Patient OB Check Only Problem + OB Check Problem Diagnosis & V 22. 0/1 Problem Diagnosis & V 22. 2 V 22. 0/V 22. 1 Or Or 0500 F/0502 F/0503 F Problem Diagnosis and/or E & M: 99499 Complicated OB Diagnosis 0500 F/0502 F/0503 F E & M: 99212/3/4/5* E & M: 99212/3/4/5 *As long as the diagnosis does not affect the pregnancy, use only the E & M Code, do not use CPT codes (0500 F, 0502 F, 0503 F).

And…. . Be sure to add Q 0091 whenever pap smear is done, even for the Post Partum visits.