Wiki 13 Visit Rule"


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Does anyone have a source for the 13 Visit rule in billing obstetric care beyond the typical 13 visits? I know I've read about it but can't find which publication it was in. Thanks
I check with each payer as this situation comes up - some payers will allow you to bill an E&M code for OB visits beyond 13 but some payers will not pay for any more than 13.

If you have a copy of the ACOG OB/GYN Coding Manual it gives a run down of what is included, excluded, etc.

For code 59400 it says:
"Services INCLUDED in Global Service when performed (Do Not Report Seperately):
Included antepartum services:
Monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery..."

In our office we don't see the pt until they are about 8 weeks since the LMP. So that figures out to be 13 visits.

At the end under Additional Comments it states:

"If a patient is seen for more than 13 antepartum visits due to a complication related to the pregnancy (eg, bleeding, gestational diabetes), report the visit seperately".
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This information is also in CPT in the notes at the beginning of the Maternity Care and Delivery section.