Avoiding Loss Payments and Messy Coding During OB Visits

When it comes to the data, we have the issue of what should be done. What we normally do, a routine UA at every visit. They may review antenatal lab results with the patient. So that's the data element just for lab test. And by now, you should know on the Medicare documentation guidelines it isn't the number of test that you're doing well, unless you're Trailblazer and/or you're doing Trailblazer rules.

But in general, it's not the number, it's the type. So it's all lab test with the 8,000 codes you use. Check off one box. And if you do ultrasound, then you get to check off the second box, et cetera.

So yes, and the second thing that is frequently reviewed or and/or order for the patient is ultrasound. Sometimes the physician particularly at a first visit will review and summarize the pertinent OB history that impacts this pregnancy particularly if she's very high risk.

And sometimes he may do an independent review of an ultrasound that was performed and interpreted at another site because he wants to feel the comfort level on this particular one. And if they documented that, you're not billing for the ultrasound but you're billing for the interpretation and you take credit for that in medical decision making.
The table of risk is the one that we are all familiar with that breaks it into minimal, low, moderate and high based on the presenting problem, diagnostic procedures ordered and management option selected.

However, this table is a little bit different because physicians who used to be on the ACOG coding committee got our heads together and said, “You know, the risk table that was developed for the Medicare documentation guidelines doesn’t seem to apply. It's hard to figure out where do obstetric things go.”
So we sat down and decided if this was the presenting problem, what would be the risk level. If this was the diagnostic test that you ordered, this is where it would fit. And here is the management option selected.
So this table is going to give you concrete example for obstetric patients. “Hmm, am I going to call this an acute uncomplicated problem or is this an acute illness with some systemic symptoms?” and things like that.

So remember, the risk table is not the end of the E/M service. It's not the only thing that you look at. But it is one of the two elements that would help you finally decide what your level of medical decision making is. So I feel that this may be an important resource for you. And it's specific only for obstetrics. It's easy enough to see where things fit in GYN. But for OB, it's a little more difficult.

Okay. So when we're going to be leveling that initial H&P, we need to understand first of all that that initial H&P was valued under the RBRVS system. That means how Medicare has assigned the value.



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