How to Report Annual Exams for Pregnant Patients: Billing Guidelines
Test your knowledge with the following scenarios.
Annual Exams for Pregnant Patients
To professionally and economically optimize the financial performance of your ob-gyn practice, it’s imperative to decipher whether you are reporting an annual exam or initiating global maternal care. Test your knowledge with the following scenarios.
Scenario 1: If a pregnancy is diagnosed during an annual patient exam, is it possible to still report the annual exam?
Scenario 2: If the patient comes in for her annual exam already knowing she’s pregnant, what reporting protocols should be followed?
Scenario 3: If the patient walks in for an annual exam with a different presenting complaint and the pregnancy is discovered, can you still report the annual exam?
Want to discover the answers?
Hint: The transformation towards impacting global maternal care isn’t always as straightforward. At the start of any patient visit, it is possible that the pregnancy status might be unknown, but coding protocols should be implemented according to the following rule: code based on what you know at the end of the visit.
Answer 1: Reporting the Annual Patient Exam Once the Pregnancy Is Discovered
For the first scenario, if the ob-gyn discovers a pregnancy during an annual exam, the pregnancy can still be reported in the annual exam. Code the pregnancy diagnosis to the diagnostic exams or labs with the following codes:
- Annual exam code (99384-99386 for new patients or 99394-99396 for established patients). Link this to Z01.411 (Encounter for gynecological examination (general) (routine) with abnormal findings) or Z01.419 (without abnormal findings)
- Urine Pregnancy test (e.g., 81025, Urine Pregnancy test, by visual color comparison methods) linked to Z32.01 (Encounter for pregnancy test, result positive)
Routine pregnancy codes like Z34.00 (Encounter for supervision of normal first pregnancy, unknown current trimester) are not necessary since the visit was preventive and not related to routine obstetric care. Reporting Z33.1 (Pregnant state, incidental) is optional and indicates that the visit was not initially related to pregnancy care.
Conclusion: Since the ob-gyn initially did not intend on monitoring the pregnancy during this first visit, code the visit with Z32.01 and begin the obstetric record at the next visit. Starting the obstetric record before the confirmation of pregnancy might lead to the entire visit being considered part of global obstetric service.
Note: Physicians are instructed to begin the obstetric record flow sheet only once the pregnancy is confirmed in the first appointment. This helps avoid confusion and ensure accurate billing and coding.
Remember: Your record should include details of what you know by the end of the appointment. If the ob-gyn finalizes the pregnancy diagnosis, use the appropriate diagnosis code ( Z32.01) for a positive pregnancy test.
Answer 2: Reporting the Annual Exam When Pregnancy Is Known
In the second instance, if a patient enters for her annual exam whilst aware that she is pregnant, the physician should report and code for both the annual appointment and a urine test done to confirm the pregnancy:
- Urine Pregnancy test code (e.g., 81025) relative to pregnancy diagnosis (Z32.01)
- Annual exam code (99384-99386 for a new patient or 99394-99396 for recurring patients) relative to Z01.411 or Z01.419
Be aware: Avoid billing and coding for a low-level service (such as 99211) unless coupled with a separate, significant evaluation and management (E/M) service regarding the pregnancy. In most cases, the physician will confirm the pregnancy and schedule the patient for a full obstetric visit, which contributes towards global maternal care.
It’s usually easier to schedule a separate appointment for initiating prenatal care rather than trying to get an ultrasound covered during the annual visit.
Answer 3: Reporting the Annual Exam with Other Complaints
In the third scenario, if the patient presents for a regular annual checkup in addition to some complaints, and a pregnancy diagnosis is uncovered, the doctor can still report the annual exam. The additional lab work or diagnostic exam carried out to address other complaints may justify a higher-level E/M service, provided it is separate from the annual exam:
- Higher-level E/M service code (e.g., 99214, Office or other outpatient visit for an established patient... 25 minutes face-to-face) with modifier 25 (Significant, separately identifiable E/M service) added, linked to the diagnosis for the other issues.
- Urine test code (e.g., 81025) linked to Z32.01
- Annual exam code (99384-99386 for new patients or 99394-99396 for established patients) linked to Z01.411 or Z01.419
Note: Make sure that the E/M services for the other complaints is clearly distinctive from the regular annual exam. Avoid doubling the service codes. This could lead to denials. Additionally, it may mean coding a lower-level E/M service for the other complaints.
All things considered, it is important to comprehend the importance of coding in boosting practice revenue.By accurately coding clinical obstetric visits, physicians can earn upto $150 to $200 or more. This is because the first visit is paid, and therefore coded separately. It is not included in the global period. The global period will start after the initial patient visit.
Outsourcing OBGYN medical billing services to a seasoned partner is essential in order to boost practice revenue and ensure optimum financial output. BillingFreedom possesses 10 year of seasoned expertise with offering comprehensive specialty medical billing services. For a more detailed understanding of what we offer, click here.
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