You can get increased payments when your ob-gyn provides additional visits outside of the normal global ob package; however you’ll have to ensure you have coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding skills.

Be firm on perfect ICD-9s

To demonstrate the reason for the additional service, you have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code. You can add this to the claim that includes the global service or you can submit it as an additional claim.

Here’s an example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is tended to 19 times due to developing pre-eclampsia. Post delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 while three of the visits have more extensive documentation that supports reporting 99213.

To add to it, post delivery, the patient experiences prolonged pain and irritation owing to a hemorrhoid. The ob-gyn tends to her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. In the end, the ob-gyn rechecks the patient at her six weeks postpartum visit.

Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services as well as the diagnoses that depict why the patient required the additional services.

Heads up: Observe the fifth digits of these ICD-9-codes. The digit ‘3′ that takes place in most of these codes has become a ‘4′ in the last ICD-9 code to indicate a postpartum condition rather than an antepartum one. In other words, the patient has been discharged from the hospital after giving birth. Using ‘3′ indicates she did not deliver during the hospital stay.

To add to it, after delivery, the patient experiences prolonged pain and irritation owing to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post delivery. In the end, the ob-gyn rechecks the patient at her six weeks postpartum visit.