Wiki Prenatal Coding (Commercial Insurance)

[epnorman]

Hi all - we have a patient who presented one time in the office for prenatal care. She was previously seen by another provider at a different office for her prenatal visits but when her insurance changed she was told she wouldn't be able to see the other doctor, so she came to us. However, after looking into her insurance, we found that she can still see her previous provider so she is going back to the other doctor.

How would you all code this visit? Would you make it a new patient E/M with incidental pregnancy or would you code it as a prenatal visit? At our office, we use 99024 for (commercial billed) prenatal visits until the delivery.

Thanks for the help!

 

[jdibble]

If you saw the patient for the one visit only, I would bill for a new patient visit with the dx code for routine OB. You can't use incidental unless the physician states that the visit was incidental to the pregnancy - and you did see the patient for a routine OB visit. You cannot use the 99024 as there is no fee for this code.

According to the CPT book, if you see an OB patient only for visits 1-3, you would use the appropriate E/M code. If you had seen the patient 4 or more visits, then you would use the appropriate Antepartum care only visit codes. However from your question, it appears you only saw the patient once - so use the appropriate E/M code!

Hope that helps!

 

[jenna112604]

Pn e/m coding

Hello!
Can anybody direct me or tell me if there is an audit sheet for prenatal billing. I work in an OB office and constantly
have to break down prenatal billing due to insurance changes, missed abs, transfers....etc. I cannot find anywhere
that provides a breakdown of how to correctly code those visits. Using the 95, 97 guidelines isn't appropriate for
management of a pregnancy...in my opinion.
Thanks in advance for any help!