If pregnant atient at 31 week of gestation visit gynacologist for first time due to late transfer of care so her intial vist is 59425 i need to ask about her subsequent visit with gynacologist is it gonna be office visit or subsequent prenatal visit 0502f,
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Wiki Late transfer of care subsequent visit
- Thread starter rehamebram@gmail.com
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59425 would not be coded for an initial visit, or do you mean that the first OB is charging 59425?
Yes i mean first ob visit will be 59425
I am asking what will be subsequent prenal code for this patient ?
nielynco
Expert
I am still not sure what you are asking. Code 59425 is a "global" antepartum visit code. It can only be billed with the OB provider has seen the patient a total of 4-6 times before another provider delivers, or there is a transfer of care, or termination of pregnancy. The code 59426 is a global code you would bill instead if the patient was seen 7 or more times in antepartum period (and you are not billing globally). If the patient is ONLY seen for 1, 2 or 3 visits before care is no longer provided by your group, you bill each visit separately with an E/M service based on the provider documentation for level of service. The only possible caveat here is that some Medicaid programs have their own rules for billing antepartum care and you must follow their guidelines to get paid. In the past I have seen them require 59425 for EACH visit, some have wanted 59425 for visits 1-4, and 59426 for visit 7-13, and some will only accept the problem E/M codes for each visit. But if you are wondering if you can bill globally if the patient was delivered by your provider when she presents late for care, it will depend on whether there was care provided by another practice initially. If there was, you would have only a few options: bill for global code if allowed with a modifier -52 (for reduced services in the form of fewer antepartum visits), or itemize the antepartum visits you provided (using the CPT rules I mention above) followed by the delivery with PP care code. If the patient presents late for antepartum care and never been seen by any other provider, ACOG has suggested that you bill globally without the modifier -52 as more intensive work will be required prior to the delivery to make up for the lack of previous care.
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