Ob-Gyn Coding Alert

Question: An ARNP (advanced registered nurse practitioner) is sending me her ob patients in the last seven to eight months of pregnancy to establish care here. We share visits during those last couple of months, and I deliver. How should the antepartum visits be billed? If I bill 59425/6 (antepartum care only) the ARNP has trouble getting paid. Should I bill office visits or consultations?

Michael B. Smith, MD
Federal Way, Wash.

Answer: The correct answer clearly depends on the contract the ARNP has with the payer that allows him/her to get paid for providing services during pregnancy. Some payers only allow the delivering professional to bill. If some of the antepartum visits are provided by a CNM (certified nurse midwife) or ARNP, this level of provider would bill those visits, but the amount would be deducted from the global fee.

In other cases, the contract stipulates that the ARNP or CNM gets to bill the global code, but the physician who provides services for this patient has to bill the CNM or ARNP directly to get paid. The only way to know for sure how to bill in this situation is to contact the payer and get the information in writing to avoid similar problems in the future.

Clearly, if you are asked for your opinion or advice and you give it to the ARNP in writing, you could bill for a consultation. But routine antepartum care in the absence of problems cannot be billed this way, and CPT only allows the office visit codes to be billed when you see the patient fewer than four times (in total) or when the reason you are seeing her is unrelated to pregnancy.

Source for this reader question is Melanie Witt, RN, CPC, MA, former program manager for the American College of Obstetricians and Gynecologists (ACOG) department of coding and nomenclature and an independent coding educator in Fredericksburg, Va.