The Do’s And Don’ts Of Levelling OB Visits

In some practices, resources are allocated and money to the physician for bonuses and productivity et cetera are handled via the E/M levelling service. It doesn’t matter whether the patient was GYN or obstetrics. So again, it allocates these resources better, better use of physicians. And it identifies the doctors who in fact are the ones seeing the higher risk pregnancies and having to do more intense work with those patients.

Sometimes you'll have a payer that absolutely requires itemization of each and every visit. Of course in that case, someone is going to have to know how to level those visits. And that is one of the items we or definitely the item we're going to over today in quite some detail on how you would go about that. Frequently enough, the itemization issue is more with a Medicaid program for instance that would rather see that.

And then also, and finally, there are times when the physician will see the patient for a condition that is totally outside of global care on the date of service that it occurred. In other words, it could be a visit in which the patient is being cared for something that is totally unrelated to pregnancy. Or she could be what? Going to the hospital, being seen and labor and delivery OB and admitted for a complication. Those visits are outside of global and they should be billed in addition. But you have to know how to level those.

So what kinds of visits do we level when we're talking about obstetric care? And frankly, the answer is all of them. Every single visit that's unrelated to OB care should have a level on it of whether it's a 99212 or a 99214, et cetera.
All visits and labor and delivery which would be outpatient visit or observation care or inpatient visits for the patient should be levelled correctly and be in a position to be billed. All routine antepartum visits should be levelled even the one where that's a two liner and we did the fetal heart rate and we took a look at the fundal height and we said everything is fine; see her in two weeks, that's still a visit that needs to have a level attached to it.

Also, all complications of pregnancy, whether those are scheduled or unscheduled visit should have a level attached to them so that you could quickly pull out.

And of course all postpartum visits, the patient is showing up at six weeks. After a caesarean, she might show up in two weeks and then again at six weeks. Everything that occurs during that visit is still going to have to have an evaluation in management code assigned to it not only to account for the fact that she was there but what the actual level of service was for that particular visit.