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Help - How to code prenatal for medicaid patients

  1. #1
    Default Help - How to code prenatal for medicaid patients
    Medical Coding Books
    I am new to OB/GYN coding. Hw do we code prenatal visits for medicaid patients? Incase if the patient has 10 prenatal visits. Do we code

    the first visit - E/M code
    second visit - E/M code
    Thirdvisit - E/M code

    Since there are more than seven visits we also use 59426.

    so altogether there are three E/M codes and one antepartum code. Please help me. I am so confused.

    Thank you very much in advance

  2. Default
    Use 59426 only since there were a total of more than 7 visits. Use the e/m codes only if you have less than 4 visits total.

  3. Smile code prenatal for medicaid
    you don't mention the state you are in so I can only say that in Texas there is no global billing of maternity. Each visit is filed to medicaid with a TH modifier and then the delivery is filed as either delivery only or delivery with postpartum care. Certain managed care medicaids have just announced that they will no longer honor the delivery with postpartum care CPT. Postpartum care is to be filed separate from the delivery. Medicaid regulations can vary from state to state so it is better to check with your state's medicaid provider to see how they want you to submit the prenatal care. And if your provider is on any managed care medicaid products, check those out separately. Good luck.

  4. #4
    Default Medicaid Antepartum billing for New jersey
    I will check the medicaid and medicaid HMO state guidelines. So if the patient had 10 visits the only code to be used is 59426..... Since medicaid is fee for service, i was wondering the three E/M in the beginning should be coded along with the global antepartum code. Just trying to finalize. Thankyou very much for the replies. Any more insight on this, is much appreciated.

    Thank you

  5. Post medicaid pre natal care billing
    the only way you will know how to bill for medicaid prenatal care is to contact the medicaid carrier for the state you are billing. I can only speak to Texas medicaid which does not allow usage of 59426. EACH visit is to be filed to Medicaid as the patient is seen.

  6. #6
    Default Medicaid coding for prenatal visits
    Thank you for taking the time to provid information on coding for prenatal care.

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