Hello:
In regard to the making of ob charts for medicaid patients...it would be great if everyone followed the same practice of:
1. Amenorrhea visit - cbc, put pt in prenatal database, make chart. Place note in the computer such that it can be billed as a medical visit. Enter some info into OB chart but make sure that date of amenorrhea visit is labeled as a "medical visit"Many of these patients have issues such as pelvic pain, nausea, menstrual irregularity, etc.. This way everyone knows there is a chart made at the time of amenorrhea visit.
A substantial number of these patients will be dropped or transferred. Look at the database "drops" for August. Medicos provides services to a very unstable segment of society. Medicos had recommended waiting until patients returned for a second visit before Medicos created an OB chart. We are changing that guideline and request that billing agrees that global OB fees do not start until patients return for the post amenorrhea visit.
When patients fail to return for delivery the prenatal visits [after the amenorrhea visit] will be billed as OB visits. Our published data on Medicos' patients 2004-2006[AJCM 2009;6[2]: pp 31-35, indicates that among 100 pregnant patients, at least 25% will not go on to deliver with Medicos. We are asking that the fellowship group tighten the methodology and repeat this study on our 2007-2009 patients.
This guideline of delayed acceptance into "prenatal care" has been addresses quality issues associated with failure to recognize and refer high risk beyond our expertise. Charges of abandonment have been alleged when Medicos had 1-2 visits by a pregnant patient who never returned. Worse yet, some have bounced from ER to ER producing fragmented care and risk.
When prenatal patients have a high risk event they must receive their care with Medicos for intial stabilization and, if necessary, referral.
1.If their complication is something that can be managed by Medicos, these patients will have their high risk services billed separately from the V22.1 pregancy package. The high risk visits will create 99214,99213, or other appropriate service codes. In addition, the visit and appropriate lab/ultrasound services will be justified using an ICD-9 high risk pregnancy code V23.89 and the specific disease code for which high risk condition[GDM, PPROM, fetal demise, etc].
2. This will save time wondering and looking for charts on visits 2 and 3. It will also allow for all info from the first visit forward to be centralized.
3. It. Is a nightmare trying to guess if a chart was made but can't be found or if one was never made at all. Make it a policy that this is done at the amenorrhea visit.
4. Even if the pt decides to go elsewhere or terminate the pregnancy, after the amenorrhea visit the pt is likely to say she is a Medicos pt if she presents at a hospital with complications.
Just some food for thought.
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Last year Medicos failed to bill over $15,000 lost in confusion over these issues. Dropped or disappeared patients MUST be identified by sending these charts directly from the RMG to billing an the day that the patients are declared "dropped/referred". Subsequent visits for medical reasons will be billed as medical visits even if it is for things such as vaginal bleeding.
With best wishes for your professional success,
" Medicos-where 10 percent of the information makes over 90 percent of the difference and where,through Grace, twice the service is provided at less than half of the cost." Constructed and maintained without government grants or charity. A design laboratory for the development of mission hospitals and independent physicians who provide continuing comprehensive health care unrestricted by age, gender, organ system, and location of service. A rural simulation in a city.
Index--OB billing guidelines
