Primary Care Coding Alert

When your family physician (FP) shares maternity care outside a group-practice setting, you will have to abandon the global codes and enter the perplexing world of billing antepartum and postpartum services. Knowing what these packages include will ensure that you deliver the reimbursement your practice deserves. Some FPs who offer maternity services may not perform deliveries. For various reasons, the FP may attend to a pregnant patient's prenatal and postnatal care and have another physician, such as an obstetrician (ob), deliver the baby.

"This is especially the case in rural areas where visiting the closest ob may require traveling 45 minutes to an hour," says Ginger Boyle, MD, a family physician practicing at Carilion Family Medicine Pearisburg in Pearisburg, Va. Consequently, a pregnant woman may see her local FP for pre- and postnatal care and periodically visit an ob who will handle the delivery, she says. In this case, because the FP provides only partial maternity care, the obstetric care codes 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care), 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care), 59610 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care, after previous cesareandelivery) and 59618 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery) no longer apply, Boyle stresses. Therefore, you must break the care down and report only the FP's performed services. Antepartum Care Starts Now When dividing physicians'roles, you should pay particular attention to how you will report the before-birth services. CPT offers three coding options based on the number of prenatal visits. For one to three visits, you should report the appropriate E/M code per visit, according to CPT. If the FP sees the patient four to six times, CPT designates 59425 (Antepartum care only; 4-6 visits). Finally, 59426 ( 7 or more visits) describes seven or more antepartum visits. Because 59425 and 59426 include multiple visits, you should report either code only once. For instance, if the physician sees the patient for five visits, you should report 59425 once, not five times. In all likelihood, if the FP assumes the primary and initial care and the ob handles some workup and the delivery, you will use 59426, Boyle says. For instance, the primary physician may see the patient for the first, monthly and weekly visits, and the delivering doctor may see the woman for the 18-to-20-week visit with ultrasound and the delivery. If any problems arise or the pregnancy goes past 40 weeks, the FP will turn over care to the delivering physician. [...]