Ob-Gyn Coding Alert

Question: We saw an obstetric patient for 11 visits and then she changed her insurance carrier. She is still antepartum with possibly 15 more visits to go. She isn't high risk, but she has a history of miscarriages and is comforted by her visits. Which portions should I report to which payer? Can I bill 59426 to both carriers along with the delivery and postpartum care code?

South Carolina Subscriber

Answer: You should bill 59426 (Antepartum care only; 7 or more visits) to the first insurance company and 59425 (... 4-6 visits) to the second if four to six visits are its responsibility. If, by the time she delivers, your ob-gyn sees her only three times under the second insurer, you should report the appropriate established patient E/M service code (for example, 99212) for each visit instead of using 59425.

In addition, you should report the appropriate code for delivery with postpartum care -- such as 59410 (Vaginal delivery only [with or without episiotomy and/or forceps]; including postpartum care) -- to the second payer.