Revenue Cycle Insider

Question: If multiple healthcare providers from the same ob-gyn practice saw a patient during the patient’s pregnancy, can we bill 59425 (Antepartum care only; 4-6 visits) or 59426 (… 7 or more visits) for the antepartum care? Or should each provider bill the individual evaluation and management (E/M) CPT^® codes?

Revenue Cycle Insider Subscriber

Answer: If the providers work for the same ob-gyn practice during the patient’s pregnancy, then you can total the visits to report either 59425 or 59426 for the antepartum care visits. However, if the providers saw the patient for less than four visits, then you’ll assign the appropriate E/M codes per the CPT^® guidelines.

According to the CPT^® guidelines, antepartum care includes the following:

• “Initial prenatal history and physical examination;
• “Subsequent prenatal history and physical examinations;
• “Recording of weight, blood pressures, fetal heart tones, routine chemical urinalysis, and monthly visits up to 28 weeks gestation;
• “Biweekly visits to 36 weeks gestation; and
• “Weekly visits until delivery.”

You’ll separately code any other visits or services during the antepartum time period.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC