Primary Care Coding Alert

Question: A family physician follows a patient throughout her pregnancy. During delivery, an obstetrician comes in to do a vacuum extraction and delivers the baby. What credit does the FP get? 

Colorado Subscriber

Answer: Because the global ob charge (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) includes the delivery, you should not use this code. You should instead report the antepartum and postpartum visits separately.
 
Choose the antepartum care code based on the number of visits the FP had with the patient during her pregnancy. You'll most likely code seven or more visits with 59426 (Antepartum care only; 7 or more visits). But if the FP sees the patient four to six times, you should assign 59425 (Antepartum care only; 4-6 visits).
 
For one to three antepartum care visits, you should assign the appropriate E/M code(s), such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...).
 
Link the antepartum care to the appropriate ICD-9 code. If the FP didn't diagnose the patient with any complications, you would use the pregnancy supervision V codes. For a first pregnancy, report V22.0 (Supervision of normal first pregnancy). If this is a subsequent pregnancy, assign V22.1 (Supervision of other normal pregnancy).
 
If the FP also assumes all postpartum care, you should report 59430 (Postpartum care only [separate procedure]) with V24.2 (Routine postpartum follow-up).
 
Don't forget: To code the FP's time in the hospital prior to delivery (for instance, the time the physician spends admitting the patient and monitoring her labor before delivery), you should use the appropriate E/M codes. For instance, the FP might bill the admission history and physical as initial hospital care (99221-99223), as well as charge for his time with the critical care codes (99291-99292) or the prolonged services codes (99356-99359) as appropriate. 
 
For more information, see the American Academy of Family Physicians obstetric coding paper online at www.aafp.org/x19566.xml.