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Pre natal visits over 13

  1. Default Pre natal visits over 13
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    If my physician sees a patient for more than 13 visits during her pregnanacy, can I still bill the 3 extra visits even though nothing out of the ordinary occurred during those 3 extra visits? Thanks!

  2. #2
    Kansas City, MO
    You will have to check your carrier guidelines on this one, but typically the answer would be no. The CPT global OB package includes all routine antepartum care, which is approximately 13 antepartum visits. As with most cases it is sometimes less and sometimes more. Most carrier guidelines will only allow you to bill extra visits if a complication was involved or it was for a reason unrelated to the pregnancy.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

  3. #3
    Default Complicated prenatal
    So if the patient does have complications and has seen the doc for several more visits than the standard global, how do we bill that out?

  4. #4
    At our facility if we provide more visits then insurance allows, I believe our billing dept still bills the service, to inform the insurance company of the services provided, although i dont think we get reimbursed. Now if the patient has 'complications" for example if the patient comes in with nausea and phenergen is prescribed for the patient and physican documents you could code as a problem visit with an E and M code with the pregnancy incidental code V22.1.
    Barbara Liimatta-CPC

  5. #5
    Our practice will bill additional visits over 15 only if there was a complication, and then we will code the appropriate E/M with the pregnancy complication dx code and modifier 25 (mostly for UHC patients).

    Stefanie Cramer, CPC
    Independent Contractor
    Medical Coding and Consulting
    Cramer Consulting

  6. Default
    I fully appreciate all the datas given.

    The physician is very much aware of how many routine subsequent visits are allowed by obstetric rule/and her payer so that she can give that much of appointments; as you say 13-15visits. Normally as per the OB antenatal rule, once a month up to 28 completed weeks, then every 2weeks till 36weeks, and weekly till term; yet after that 36weeks, as per the physician’s choice depending upon the patient’s condition. If you do a math calculation, the total number of visits goes to 15 up to 40 weeks,( taking it for granted the first visit starts as early as one month), and if pregnancy prolonged, then it can go up to 42 weeks( if the physician do not opt for induction before that). So it could be even upto17 visits totally throughout the pregnancy; this holds good for normal / routine calculated visits needed obstetrically. This is normal required visits by a full grown pregnant mother.
    (gone are those days when we started the first visit as late as 12-16weeks)
    So, even if it exceeds your number 15, it would come to pass. Isn’t it?
    It should!
    If complicated pregnancy, it is extra and it is a different entity.
    Now, my question is this: how about the number of US visits which are deemed to be routine US examinations for a normal pregnancy and even if it exceeds the normal warranted ultrasounds during this pregnancy. It is said that if the Physician feels (medically) that the patient /fetus requires a few more /much more Ultrasounds during this pregnancy, she is entitled to do them for the better evaluation and prognosis, for optimizing the management in general and yet all of those extra ultra sounds are also considered to be “routine (US) examination” , no matter how many extras she did.
    How about the ‘global’ work-out in these situations (on ultrasound perspective).
    Thank you for your time.

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