Billing codes 59425 and 59426

kaessan1

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I need some help everyone. There seems to be some confusion when billing these 2 codes, are they supposed to be billed each time the member comes into the office and then the insurance company will only pay on the last claim submitted or should the insurance company pay on each claim submitted? For example 59425 is for 4-6 visits, should we be billing this code for each visit and once the member hits the 7th visit we would start billing 59426? PLEASE HELP I AM SO CONFUSED:confused:
 

epitman25

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You would bill 59425 on the 4th, 5th, or 6th (the last) visit the patient was seen there. You don't bill 59425 every time. If they happen to come in for a 7th (or more) visit, you would delete 59425 and bill 59426 on their final antepartum visit.

Hope that helps!
 

hswift

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These codes are for billing non-global obstetrical care -if the patient miscarries, changes insurance or transfers care from your practice. You would not use them for each visit, but total all visits made for antenatal care and then use the appropriate code. Levels of E/M are used for the first three visits each, if there are four to six visits then use 59425 in place of the separate E/M codes. If there are 7 or more visits then use 59426. Check with your insurance carriers for their specific rules. In our billing system, we track the ob visits with a dummy code that does not have a dollar amount. If the global billing is ended for any reason, we bill the total number of visits using the above guidelines.
Hope this helps
 
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Cleveland, Ohio
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Billing coding 59425 or 59426

What if the plan was to bill global code 59400. but the midwife didn't make it to the hospital on time and the baby was caught by another doctor not from our practice,can I use either 59425 or 59426 for the prenatal care visits?
 

Lori Julian

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Bay City MI
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If you're providers did not perform the delivery then you will need to unbundle your obstetrical services and report the antepartum and postpartum separately.
 
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