OB/GYN

Return Home          Contact Us

OB/GYN Coding Wire Archives
Conditions of the Perinatal Period Female Genitalia Pathology Index OB Management.COM Gynecological Pathology Pregnancy, Childbirth, and the Puerperium
Virtual Hospital - GYN Obstetrical Handbook ACOG Coding Corner Reproductive Coding Q&A  
OB GYN Net
includes procedures
       
Understanding the Apgar Scoring System
Understanding the Apgar Scoring System
Have you ever thought about what the Apgar Score on a newborn really meant and how it was obtained? The Apgar Score is a rating system used to evaluate the health of newborn infants. The test is given one minute and again at five minutes after birth. A rating of zero, one, or two is given in each of five categories which include color, breathing, heart rate or pulse, muscle tone, and response to stimulation. A total score of three or less is an indication the newborn’s condition is critical and requires emergency attention. A score of seven or higher means the newborn’s initial vital statistics are good. Research on the extended Apgar Score of five minutes, which is really a recheck, has shown the test to be a fairly reliable indication that the newborn has a good chance of survival. A high score does not guarantee that a child’s long term outlook is completely positive, because the Apgar Score can not check for all complications.

Physicians had no way to assess the health of a newborn in the critical first minutes of life until the early 1950s. Conditions that might have been corrected early sometimes turned out to be fatal. In 1952, Virginia Apgar, a physician developed the scoring system that is currently used today for evaluation of newborns. She spent years studying the effects of anesthesia in childbirth to develop this system.

Five Components

Five components, each with its own standards, make up the Apgar Score. The categories and ranges are as follows:

Color: A newborn who has a healthy pink skin tone receives two points, a pale or bluish skin receives zero points. The majority of newborns have pink bodies and lips, but bluish color hands and feet. This color receives one point. A bluish color all over may mean the newborn has heart or lung problems, an airway blockage, or has inhaled amniotic fluid.

Breathing: A newborn should gasp or begin to breathe at birth. Normal breathing gets a score of two, irregular breathing scores one. Zero is given to a newborn who makes no effort to breathe. Irregular breathing can mean the newborn lacks oxygen, has an infection, has central nervous system problems, or has a depressed respiratory effort because of anesthesia that was administered to the mother during childbirth.

Pulse: The normal heart rate at birth is between 120 and 160 beats per minute. No detectable heartbeat is scored a zero; less than 100 beats per minute is scored one; and for a heart rate of 100 beats per minute or more is scored a two.

Muscle tone: The newborn should move his or her arms and legs at birth. Limpness or poor muscle tone are usually caused by lack of oxygen, central nervous system trauma, or drugs administered during childbirth. A limp newborn is scored zero. Some movement is given a one, and active movement gets a score of two.

Response to Stimulation: A newborn is stimulated at birth by inserting a tube through a nostril into the throat. This causes a cough, grimace, or sneeze. If there is no response, he or she is scored a zero. A grimace alone gets a one, and a grimace with cough or sneeze is given a two.

The highest total Apgar Score is ten. It is not unusual for infants to score a seven at one minute of age and nine or ten at five minutes of age. At five minutes of age, newborns generally have healthier skin tone and are breathing normal.

Physicians can take immediate measures if needed to ensure a newborn’s survival with the information provided by the Apgar Score. Therefore, a delivery room team should be prepared to handle a crisis and at least one person who is skilled at neonatal resuscitation should be present at each delivery. Apgar Scoring plays a significant role in the assessment of newborns.

How to Bill Antepartum (Carrier Rules)
BCBS-NE: Wants you to bill antepartum visit code 59425 or 59426 for each visit with a separate charge for each visit. Wants a paper claim with the OB record attached.

United Health Care: Antepartum code 59425 and 59426 are global codes and # of units should be 1. Requires a paper claim with copies of the ob record.

Medicaid NE: Bill antepartum as one rate but indicate number of visits in the visit field.

United wants a paper claim with copies of the OB record.

Definition of minimum number of visits required to be turned in as a global

BCBS-NE 4 or more

Consultec 4 is the minimum number of visits for global ob care. Use 52 is you use less than 4

United - Needs 3 months of continual care for global code to be billed.

Medicaid NE - Total OB can be billed as long as the patient has been seen for some prenatal care. If the patient hasn't been seen before bill delivery only.

BCBS-NE: Wants you to bill antepartum visit code 59425 or 59426 for each visit with a separate charge for each visit. Wants a paper claim with the OB record attached.

United Health Care: Antepartum code 59425 and 59426 are global codes and # of units should be 1. Requires a paper claim with copies of the ob record.

Medicaid NE: Bill antepartum as one rate but indicate number of visits in the visit field.

United wants a paper claim with copies of the OB record.

Definition of minimum number of visits required to be turned in as a global

BCBS-NE 4 or more

Consultec 4 is the minimum number of visits for global ob care. Use 52 is you use less than 4

United - Needs 3 months of continual care for global code to be billed.

Medicaid NE - Total OB can be billed as long as the patient has been seen for some prenatal care. If the patient hasn't been seen before bill delivery only

 

Hosted by www.Geocities.ws

1