ACOG often receives questions from Fellows as to whether the initial visit to confirm a pregnancy may be reported as an E/M visit separately from the global OB package.
The initial OB visit may be reported as an E/M service under certain conditions. Even if the patient has taken a home pregnancy test, the initial visit may still be billed as an E/M service as you will be officially confirming the pregnancy.
When coding for the “initial ob visit”, there are a few things that have to be taken into consideration. First you have to determine if the patient is there for a confirmation of pregnancy or if the pregnancy has already been confirmed. The second thing that needs to be determined is if the OB record has been initiated. Once this has been established you can determine how the visit should be reported.
Here is an example to help clarify the issue:
If a patient presents with signs or symptoms of pregnancy or has had a positive home pregnancy test and is there to confirm pregnancy, this visit may be reported with the appropriate level E/M services code. However, if the OB record is initiated at this visit, then the visit becomes part of the global OB package and is not billed separately.
If the pregnancy has been confirmed by another physician, you would not bill a confirmation of pregnancy visit.
The confirmation of pregnancy visit is typically a minimal visit that may not involve face to face contact with the physician (for an established patient). The physician may draw blood and prescribe prenatal vitamins during this initial visit and still report it as a separate E/M service as long as the OB record is not started.
Diagnostic Reporting Options:
V72.40 Pregnancy examination or test, pregnancy unconfirmed
V72.41 Pregnancy examination or test, negative result
V72.42 Pregnancy examination or test, positive result
The physician should report V72.40 if the encounter is to test for a suspected pregnancy and the patient leaves without knowing the results. If the pregnancy test is negative, report code V72.41. Report code V72.42 if the pregnancy is confirmed but the obstetrical record is not initiated. This diagnosis code is also used when the physician sees the patient for the confirmation of pregnancy but will not be providing the global obstetric care.
Global obstetrical care begins when antepartum services are provided, or the obstetrical record is initiated as part of the physician's comprehensive obstetrics work-up which includes the comprehensive history and physical.
Note that some payers may now view an initial obstetrical ultrasound performed in the office at the initial visit, as part of the comprehensive work up that initiates the global package. If this service is performed, your specific payer may view the initial visit as included in the global OB package even if the visit is reported with an E/M service code.
Not all payers follow CPT guidelines as to the contents of the global obstetrics package. You should always check with your specific payers for their definition of the global obstetrics package. Be sure to keep a written copy of any instructions.
A final point to keep in mind is that not every initial OB visit will be reportable outside of the global package. Deciding when to initiate the global OB care depends on the clinical circumstances, the physicians’ medical judgment, and payer reimbursement policies.
Questions/comments may be sent to ACOG's Coding Staff via email at firstname.lastname@example.org