Coding & Compliance Newsletter - November 2009

"When Does Global Pregnancy Care Begin?"

Correctly coding and billing for annual visits can be confusing when a patient’s pregnancy is established during the annual exam.

The intent of global billing (CPT codes 59400, 59510, 59610, and 59618), is to offer a convenient means of billing for providers who render the total obstetrical care to a woman throughout her pregnancy. Global obstetrical (OB) billing consists of antepartum care, delivery, and postpartum care, including the following:

The intent of global billing (CPT codes 59400, 59510, 59610, and 59618):

Hospital admission
Patient history
Physical examination
Labor management
Postpartum office visit
Vaginal or cesarean section delivery
Vaginal or cesarean section delivery, after previous cesarean delivery
Hospital discharge
All applicable postoperative care

However, if a patient presents for her annual exam and the urine pregnancy test (CPT code 81025) confirms pregnancy, then the appropriate annual exam would still be reported since the physician has not yet started supervising the pregnancy. The following ICD-9 codes would be reported in this case:

V72.31 – gynecological examination, and
V72.42 - positive test pregnancy exam, since the urine test did confirm the pregnancy.

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If you have any questions or need additional information regarding this article, please contact Cindy Tipton at Cindy_Tipton@MED3000.com.