Ob-Gyn Coding Alert
Don't Overlook Prolonged Services Rule
Question: The physician performed four antepartum visits with patient (high risk). Nine days later at 22 weeks, the patient’s water broke, and she went into labor losing the baby. Another physician at another hospital saw her. The next day, our physician saw the patient for a prolonged amount of time. How should I report this?
Georgia Subscriber
Answer: You should report 59425 (Antepartum care only; 4-6 visits) for the antepartum care, then the E/M services she was seen for after she delivered (99212-99215, Office or other outpatient visit for an established patient …) — assuming the other physician will be billing the delivery.
If prolonged services apply (99354-99357, Prolonged services with direct patient contact), see the appropriate codes in CPT® for this add-on service as well as the criteria for reporting them.
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