Ob-Gyn Coding Alert

Question: If a patient has not received any prenatal care before coming to our office at the end of her pregnancy, can we still report the global fee if we've seen her only one or two times before delivery?

Idaho Subscriber Answer: According to the American College of Gynecologists and Obstetricians, you can bill a global obstetric code (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) if you've seen the patient for only a few visits before delivery. But you should append the code with modifier -52 (Reduced services), the association advises.

Some payers may not accept this coding, however, and will insist that you itemize each antepartum visit. In this case, you should make sure that the E/M service level reflects the ob-gyn's more intense work level because of inadequate prenatal care. In addition, you should submit the code for delivery plus postpartum care (for example, 59515, Cesarean delivery only; including postpartum care). Be sure to include the diagnosis code V23.7 (Insufficient prenatal care). -- The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.; and Peggy A. Stilley, CPC, office manager for Women's Healthcare Specialists, an Oklahoma University-based private ob-gyn practice in Tulsa.