Wiki Billing for Prenatal Visits Only

[yeissell]

Hello,

My practice only bills for prenatal visits, usually from week 8 thru week 27. For CPT coding, we usually report the 'prenatal care only' code for 4 to 6 visits. Can someone please advise on which ICD10 codes should be reported on the claim form? So...

1. Which trimester should be reported on the claim (Z34.XX? ) if the physician has seen the patient from the 1st to the 3rd trimester? and...
2. How many weeks of pregnancy should be reported on the claim (if the physician has seen the patient since week 8 thru 27)?

Any guidance you can provide would be greatly appreciated.

Thank you,
NG

 

[abernathy4]

Hello, when my team bills for "prenatal care only" (CPT 59425 or 59426), we use the patient's last visit for date of service for the charge/claim. The diagnosis codes would be for example (A normal 2nd pregnancy seen until week 38 gestation, Z34.83 Supervision of other normal pregnancy, third trimester) or if the patient had complications or exceptions to the "normal" and other appropriate dx to link, use the appropriate "O" code for the trimester she is in on the date of service you are using for that visit, and then add the "problem" diagnoses that she has had at her prenatal visits example (O30.013 Twin pregnancy, monochorionic/monoamniotic, third trimester, O43.023 Fetus-to-fetus placental transfusion syndrome, third trimester, and Z3A.33 for weeks gestation).

United Healthcare plans do require the date span of the prenatal care to be on the claim, that is the only difference. I still use the same diagnosis code process.

 

[yeissell]

Hello, when my team bills for "prenatal care only" (CPT 59425 or 59426), we use the patient's last visit for date of service for the charge/claim. The diagnosis codes would be for example (A normal 2nd pregnancy seen until week 38 gestation, Z34.83 Supervision of other normal pregnancy, third trimester) or if the patient had complications or exceptions to the "normal" and other appropriate dx to link, use the appropriate "O" code for the trimester she is in on the date of service you are using for that visit, and then add the "problem" diagnoses that she has had at her prenatal visits example (O30.013 Twin pregnancy, monochorionic/monoamniotic, third trimester, O43.023 Fetus-to-fetus placental transfusion syndrome, third trimester, and Z3A.33 for weeks gestation).

United Healthcare plans do require the date span of the prenatal care to be on the claim, that is the only difference. I still use the same diagnosis code process.

Thank you!