Primary Care Coding Alert

Many family physicians (FPs) provide antepartum care for pregnant patients with chronic conditions because the FP is familiar with the patient's problem. Although the obstetrician (OB) will deliver the baby and provide postpartum care, the FP monitors the condition and sees the patient for routine prenatal visits. But coding for antepartum care is not always as straightforward as just using maternity codes 59425 (Antepartum care only, 4-6 visits) or 59426 (... 7 or more visits). Various coding options exist depending on how the patient's chronic condition may affect labor and delivery. When the FP sees a pregnant patient one to three times only, he or she codes those visits with the appropriate-level E/M office visit code (99201-99215). "The coding changes when the patient has a chronic condition," says Victoria Jackson, owner and executive director of OMNI Management Inc., a medical practice management firm in Lake Forest, Calif. When treating a pregnant patient with a chronic condition, an FP may provide different types of antepartum care: 1. Chronic condition that has to be monitored by the FP. Some pregnant patients have chronic conditions that will not necessarily complicate labor and delivery but need to be monitored closely. When the patient comes in to have her chronic condition checked, use the E/M office visit codes (99211-99215) for these visits and the diagnosis code for the condition. For example, a pregnant patient with severe asthma continues seeing her FP so the doctor can monitor her condition. Code these visits with the appropriate E/M office visit codes and 493.xx (Asthma) for the chronic condition. It is not necessary to use the diagnosis code for pregnancy in this case because the FP is treating a separate problem that will not affect the pregnancy.

"Although the patient is pregnant, if the physician is checking up on her condition and not providing the routine antepartum care services, you can't use the antepartum codes," says Joan Hubball, FNP, nurse practitioner at the Fernald Center in Waltham, Mass. But if the patient comes in for routine antepartum care, and the doctor also separately treats the chronic condition, use the antepartum care code and the appropriate-level E/M code appended with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). "Usually, however, when the chronic condition will not affect labor and delivery, the physician will not combine those visits," Hubball says. 2. Chronic condition that may complicate labor and delivery. When a pregnant patient with a chronic condition that could affect the pregnancy visits her FP for routine antepartum care, you should use 59425-59426. You should also report the diagnosis code for the chronic condition and/or the [...]