Tricks for OB/GYN Coding - Do Not Be Scared!

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During a prenatal visit, the provider documents that the patient used 648.3X in ICD-9 reads Drug dependence. If dependence is not specificed in the documentaiton
marijuana until she found out she was pregnant, then she stopped. this would not be used. Query of the provider would be recommended. 648.9X - other conditions
How would this be coded? If the provider documents that the
in the mother could be used with secondary code 305.X for a history of drug use.
patients continues to use marijuana, how is this coded?
What is the correct coding for an OB patient who will be less than 16
years old when she delivers? 659.83 and V23.83?
What is the correct coding for an OB patient who has a history of
Hepatitis B?

V23.83 should be used for the provider that is supervising the pregnancy. V23.83 excludes
658.8X.
If documentation supports a history of Hep B use 647.6X other viral conditions complicating and
use a secondary code ov V12.9.

My doctor wants 58660,59 coded with 58661 on an extensive

surgical procedure. Each code was done on a separate side and
58660 is not getting paid. Is this a simple fix and can I just use LT and
RT modifiers?
An OB patient develops preeclampsia prior to delivery. After delivery
her blood pressure remains elevated, so she is advised to return to
her provider one week after her discharge for a blood pressure
check. A routine 6-week postpartum visit is also scheduled. Can the
1-week postpartum blood pressure check visit be billed outside of
OB global care, since it is for a condition that is NOT part of a routine
pregnancy/peurperium?

58660 is a column 2 code for 58661 and based on NCCI edits these two cannot be unbundled. Bill
the most extensive procedure.

Regarding your slide when a patient comes in for an unrelated

problem or an issue complicating the preg., is it necessary to also
include code V22.2 (preg. state incidental)?

No - the Chapter 15 codes for complication of pregnancy indicate the patient is pregnant it is not
necessasry to use V22.2 to show incidental pregnancy. V22.2 is only used if the documenation
indicates the condition does not complicate the prenancy.

The post partum blood pressure check would be billable outsidethe global - based on the level of
history, exam, and MDM that is documented. If this is a nurse providing the service 99211 is the
only code that is billed. Remember to use the correct 5th digit of 4.

What is the proper way to bill the hospital care provided after
Bill the service that is provided - i.e. delivery of placenta, admission, etc.
delivery for a patient who delivered at home or on the way to the
hospital
Our providers get called in to take over problem deliveries at the
That is correct
hospital for the family practitioners, I am billing for only the delivery
code, is that correct?
Medicaid requires visits and delivery/postpartum to be billed as
individual codes instead of bundling. If patient has Medicaid
secondary to primary commercial payor, how is recommended to
bill?
currently we don't bill for postpartum visits related to postpartum
depression, I've done some research and it looks like we should be?
are there any guidelines regarding this? thank you.

If I understand your question this can be a problem. If you bill global for the primary and
Medicaid wants the billing split out, I would just make sure that I had a written policy to support
why this is being done.
Post partum depression is a complicaiton and if documentation is adequate and the problem is
significant I wiould bill this outside the global. These discussions can become quite time intensive.
Modifer 24 could be used to show that this service is unrelated to the OB care.
Payers may still deny however.

F/U for inpatient care provided for patient who delivered at home. 59430 is indeed for post partum care - however it includes inpatient and outpatient care. Are you
Care provided was admission and subsequent day follow up. I have providing post partum care through the 6 weeks and perfomring the 6 weeks post partum visit in
been billing inpatient E&M codes; however, a coworker thought we the office?
should bill 59430 for post partum care if the patient is our patient
prior to delivery.

Our OBGYN providers have begun using V72.31 as the code when
they do a pelvic exam with Pap smear as well as gonorrhea &
chlamydia cultures. Am I correct that I don't need to include V76.2
for the Pap smear, because that is part of V72.31?

Notice that V76.2 excludes V73.81 and V72.31 - you are correct.

In our facility, we are told that only V70.0 may be used with the
preventive medicine codes (99395, 99386, etc.). You seemed to
indicate that V72.31 can be used with the preventive exam codes. Is
this correct?
We use these codes for medicare for preventive care and they deny
them saying they are routine. What dx codes do you use where you
get paid.

V70.0 is used for routine general medical exam - V72.31 is for a routine gyn exam.

I am not sure what codes you state you are using - G0101 and Q0091 or the 993XX codes ?
Medicare will never reimburse for 99387 - G0101 and Q0091 are reimbursed with Dx V76.2,
V76.47, V76.49, V72.31 or high risk V15.89.
Low risk is paid every other year Covering/On call doctors - please confirm, should not bill for service if the physician being covered has already billed a global charge - and the patient has no
rendered. Instead the doctor that is being covered should bill? Just complicaitons there is nothing for the call covering to bill. If you are covering - and for instance
got confused by your statement that if the doctor being covered
you perform a delivery and the physicain you are covering for is not billing for the delivery, you
can't bill, then the covering/on call doctor can't bill.
should bill for that delivery. If you are call covering and doing post surgical rounds for a patient
without any complications there is nothing to bill. The post operative care is included in the
surgical code.
How do you differentiate when to bill 99397 and G0101 and Q0091? It is a good policy to ask the patient what service they are expecting to receive. "Do you just want
What additional documentation would you look for to support the the service that is covered or do you want the entire preventive service. "
preventive and carve out what is covered?
If all the elements of the preventive service are documented in addition to the G and Q elements
Medicare allosws for billing of all services - but make sure the patient is aware taht the preventive
service is NEVER covered by Medicare.

Is 99000 always included in E/M codes? Is it reimbursable under any 99000 is a handling charge and should only be billed when the practice encounters a fee. Most
conditions?
labs pick up specimens free of charge.
Q0091 is reimbursed by Medicare every 2 years for Screening Papanicolaou (Pap) smear,
obtaining, preparing and conveyance of cervical or vaginal smear to laboratory. Billing 99000 in
addition would not be appropriate.
What if patient is admitted over 24 hours previous to delivery? Is
If the patient is admitted before delivery those dates of service are billable outside the global
the Admit included w/ the delivery? What about the inpatient e/m's package.
on the days previous to delivery?
If the patient is in active labor for longer than 24 hours ------When CNM attends labor intending to deliver but complications lead Admission could be billed,
to sending patient to hospital instead for delivery (not attended by
CNM) what can CNM bill if anything?
Medicaid secondary to primary commercial payor, how is
I am not sure what the question is recommended to bill?
Is 80101 reimbursable as G0431 and, if so, do we need to submit a Delete this question as I have no idea what she is asking?
CLIA waiver? How do we document complexity for reimbursement?
Covering/On call doctors - please confirm, should not bill for service
rendered. Instead the doctor that is being covered should bill? Just
got confused by your statement that if the doctor being covered
can't bill, then the covering/on call doctor can't bill.

When physicians have call covering services, the physician doing the covering will not be able to
bill for all services performed.
1. Dr A delivers the patient and bills global OB care and has Dr Z cover for the weekend for the
post partum inpatient visits. With no complications there is nothing that can be billed. Dr A
would not be able to bill for inpatient visits so the call covering Dr Z is not to bill for these visits.
2. If Dr A delivers the patient and see the patient on Day 2 for a post partum hemorrhage - this is
a billable service.
3. Dr A delivers the patient and turns the care to Dr Z (call covering) for Day 2. On Day 2 the
patient has a post partum hemorrhage and this is a billable service for Dr Z.

What code should be used for a hysterectomy performed by total

laparoscopic method meaning--all work done laparoscopically,
specimen removed via vagina whole (due to risk of CA), however,
vaginal closure done via vagina vs laparoscopically

TLH includes laparoscopically detaching the entire uterine cervix and body from the surrounding
supporting structures and suturing the vaginal cuff. It includes bivalving, coring, or morcellating
the excised tissues, as needed. The uterus is then removed through the vagina or abdomen.

How do you differentiate when to bill 99397 and G0101 and Q0091? This should be a conversation with the patient as well as the provider. If the patient wants the
What additional documentation would you look for to support the service that is paid by Medicare the breast, pap, and pelvic exam, report with G0101 and Q0091.
preventive and carve out what is covered?
When all elements of the 99397 are performed - age and gender appropriate hiostory and exam
with anticipatory guidance and risk factor reduction - this is billed to the patient, not to Medicare.
Thisis provided on the CMS website.
For the Medicare Screening Pap diagnosis do you know when the
ICD10 codes will be sent out by Medicare?

ICD-10-CM will be implemented Oct 1, 2015. We have not seen payable diagnosis yet.

My doctor wants G0101,GA billed with Q0091,GA and no E/M codes.

The ICD-9 is V76.2, the patient is 69yo and hasnt had a
PAP/screening in the past 2 years. We have had a lot of problems
with this. Why would G0101 get paid and NOT Q0091?

It is possible that another provider billed one of the codes. If that is not the case I would question
the denial - V76.2 is routine cervical pap - does the patient have a cervix? Have you tried V72.31
routine gyn exam
Look at slide 37 for all payable diagnosis - these are also provided on the CMS website.

f/u delivery at home- If I understand correctly, 59430 could be used

for a patient we are seeing from the hospital thur 6 week pp visit
(we would bill the prenatal care separately; however for a patient
we only see for pp care in the hospital, we should bill the proper
inpatient E&M codes
Patient comes in for contraceptive management and the doctor
does not perform a pelvic or pap exam. She states in the note that
this is a yearly visit and codes it with a preventative code. Is this
correct?

I would bill admission and subsequent days siince you will not be providing pp care through 6
weeks.

can you address ultrasound codes ? example can you explain the
difference in 76815, 76816, 76819?

76815 is a limited US or a "quick look", example looking for placental location or heart beat or
fetal position. 76816 is a followup limited or a re-evaluation of a problem that was previously
identified - such as fetal size or amniotic fluid level. 76819 is a biophysical profile without a nonstress test and is not looking at fetal structures (anatomy) but rather at the movement and well
being of the fetus - such as breathing, movement, heart rate, and amniotic fluid. If the BPP is
done with NST 76818 is appropriate.

Post partum depression- is this considered a billable service or

included into the gobal/ post partum care? Some providers see the
patient several times for PPD
Im having difficulty getting my providers to document their in office
colposcopic procedures. Is there anywhere that states procedure
coding/documentation guidelines?
To clarify, when an OB patient comes in for a headache, we assume
that it is complicating the pregnancy, unless it is specified it isn't. So,
we would use 648.93 and 784.0?

When the PPD is a significant problem it is considered to be outside the global.

If a patient comes in for a Well Woman Exam, but no pelvic exam is

performed by the provider because either no pap smear was
collected (not needed) or if patient is on her menses and will need to
return for the pelvic
Provider uses V23.89 and compliation of MVA and the next
antapartum visit providers changes back to normal pregnancy.
Should I continue the high risk of the MVA or normal pregnancy?

If the patient will present later for the pap only one code can be billed. Dont bill a separate E/M
when the patient returns for the pap.
Was a pelvic exam performed ? A pap is not required if not medically necessary, but certainly a bimanual exam could be performed.
If the MVA is no longer complicating I would use normal pregnancy supervision.

Read the preventive medicine guidleines in CPT - it states the history and exam should be age and
gender appropriate. I would suggest if not pelvic is done the documenttion would state why. The
preventive service codes do expect a good deal of counseling and risk factor reduction. Just
refilling OCP and taking about BC does not adequately support the code.
Annual visit does not equate to a preventive code without the required elements as stated in CPT.

Because it is a surgical procedure it should provide all elements of a surgical note. I will look and
see what info I have to back this up for you.

That is correct - the coding guidelines for Chpter 15 - OB Chapter - state that all conditions are
assumed to complicate the pregnancy unless documented other wise by the treating physicain.
This includes UTI, URI, Headache, etc. and a code from Chapter 15 would be the first listed
diagnsois.
I am wondering if you or someone else at AAPC is available for a few This can be done - yes.
additional questions regarding MFM ultrasound questions,
Perhaps a webinar on ultrasounds specifically the use of 76827 and 76828

In the early slides, you indicated to use mod 25 for antepartum visits No - 25 would not work - there is no modifier to set this apart which is the problem.
outside of global. Is this correct?
Additional information regarding 76827 and 76828 - (question also I would look at the documenttion requirements provided by AIUM or SMFM - these will provide all
applies to 76825 and 76826) if a complete study is not documented the elements that are required for the code and offer solutions when any are missing.
or performed thus not allowing us to bill CPT codes 76825 or 76827)
is it appropriate to use the follow up codes of 76826 or 76828 even
if it is the first time the patient was seen? These code sets do not
give a description for a limited study; so we are wondering if
choosing the follow-up or repeat study is appropriate base on CPT
guidelines?
We don't typically bill global services for delivery - would the 59430 59430 includes hospital post partum visits and the outpatient care for 6 weeks including the 6
still apply?
week post partum visit in the office setting- If you meet that definition then yes.