OBGYN

1
Chapter 10

• OB/GYN

2
OB/GYN Dual Provider

• Many women have their OB/GYN provider act as
  their primary care physician (PCP).
• Coders must know if the patient is being seen by
  the PCP or the specialist for coding E/M services
  and collecting co-pays.

3
Subspecialties of OB/GYN

• Review Table 10-1.
• Many OB/GYN physicians treat and diagnose
  urogenital system problems.

4
Internal Female Reproductive Organs

• Ovaries
• Fallopian tubes
• Uterus
• Vagina

5
Internal Female Reproductive Organs (cont.)
6
External FemaleReproductive System

• External genitalia (vulva)
• Labia majora
• Labia minora
• Clitoris
• Urethral orifice
• Bartholins glands
• Breasts

7
External FemaleReproductive System (cont.)
8
Obstetrics (OB)

• Treats pregnant women from conception through the
  puerperium
• Services include maternity care for the healthy
  patient (or one with complications), childbirth,
  and postpartum care for the mother
• CPT 59000 code series, including abortion

9
ICD-9-CM Guidelines

• Pregnancy codes from Chapter 11 are sequenced
  first except when the patient has HIV
• Must know reason for encounter
• V codes for asymptomatic patient, high risk HIV
  group, and counseling

10
ICD-9-CM Guidelines (cont.)

• Impending or threatened conditions
• Chapter 11 codes (630677) are placed on the
  mothers chart only
• V22.2x for a routine prenatal visit with no
  complications
• V23.x for high-risk prenatal visit

11
ICD-9-CM Guidelines (cont.)

• Principal diagnosis for delivery
• V27.0V27.9 for each delivery
• 655 codes are assigned only if a fetal condition
  is affecting the mother, such as surgery on fetus
  in utero

12
ICD-9-CM Guidelines (cont.)

• 648.0x is assigned for pregnancy with diabetes
  followed by a code from 250.0x. Use V58.67 if
  treated with insulin.
• 650 is only assigned to a normal delivery with no
  other codes as secondary.

13
ICD-9-CM Guidelines (cont.)

• Screening
• Observation
• Aftercare
• Follow-up
• Postpartum
• Counseling
• Family planning

14
Maternity CPT Package

• Antepartum, delivery, and postpartum services are
  all included in one payment!

• Initial and subsequent history
• All physical examinations
• BP and weight recording
• Fetal heart tones
• Urinalysis

15
Maternity CPT Package (cont.)

• Monthly visits up to 28 weeks
• Biweekly visits up to 36 weeks
• Weekly visits until delivery

16
Maternity CPT Package (cont.)

• Delivery
• Including admission, management of labor,
  episiotomy, and use of forceps
• Normal hospital and office visits for 6 weeks
  after delivery

17
Maternity CPT

• Any medical problems complicating delivery should
  be coded separately with E/M

18
Maternity CPT (cont.)

• More than one provider may see the patient during
  this 10-month period.
• Use the appropriate code to indicate what portion
  of the antepartum, delivery, and postpartum care
  was given (5940959410, 5941459430)

19
Obstetrical Complications

• Code for obstetrical complication is sequenced
  first
• Anemia, gestational diabetes, hydramnios, toxemia
  (pre-eclampsia), placenta previa, ectopic
  pregnancy, multiple births, etc.

20
Obstetrical Complications (cont.)

• Select E/M codes or procedure codes in addition
  for complications during antepartum or delivery

21
Abortion

• Therapeutic (TAB)
• Elective
• Spontaneous (SAB)

22
Services Separately Coded in Maternity Care

• Ultrasound
• Amniocentesis
• Special screenings for genetic conditions
• Unrelated pregnancy conditions
• High-risk illness services

23
Gynecology (GYN)

• Preventive medicine services (well woman exam)
• Screening versus diagnostic Pap smears
• Screening pelvic examination
• CMS requires G codes for exams and Q code for Pap
  smear

24
Gynecology (GYN) (cont.)

• Contraception
• Infertility
• Treatment of sexually transmitted diseases (STDs)

25
Gynecology (GYN) (cont.)

• Office procedures
• Colposcopy
• Endometrial biopsy
• DC
• Cryosurgery
• Removal of lesions of external genitalia

26
Surgical GYN Procedures

• Exploratory laparotomy
• Laparoscopy
• Vulvectomy
• Colporrhaphy
• Colposcopy with loop electrode of cervix
• Myomectomy
• Hysterectomy

27
Surgical GYN Procedures (cont.)

• Insertion of IUD
• Hysterosalpingoophorectomy
• Hysterosalpingography and chromotubation
• Hysteroscopy
• Ovarian cystectomy
• Cystocele/rectocele repair