E/M visit before Ob care: What’s OK?
<huc>Q</huc> The American College of Obstetricians and Gynecologists instructs us to bill an evaluation and management (E/M) visit with the ICD-9 code for suppression of menses (626.8) if the Ob record is not initiated. I simply need to document the patient’s signs and symptoms; if I determine she’s pregnant, I can start the Ob record at her next visit.
My question is, what other services can I provide at this E/M visit? Can I order prenatal labs? Gyn probe? Prenatal vitamins? I don’t want to cross the line.
<huc>A</huc> According to ICD-9-CM rules, you must code what you know at the end of the visit. If a urine pregnancy test performed during the visit is positive before the patient leaves, the diagnosis code is V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy)—not suppressed menses. However, 626.8 can also be linked to both the pregnancy test procedure and the E/M service.
As to what else is allowed: You can perform any service that is not normally part of the Ob global package (meaning it can be billed separately).
Prescribing vitamins and ordering labs is permissible, since these are minor activities that do not impact the level of E/M service you bill.
The Gyn probe is questionable, since it is not done unless the patient is pregnant. However, since this is generally a separately billable service, the payer may allow it.
Just be sure you’re not counseling for the pregnancy or taking pregnancy measurements, and then coding a higher level of E/M service. Any payer will likely construe this as initiation of global care.