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Proper coding of 59400

  1. #1
    Default Proper coding of 59400
    Medical Coding Books
    I work in a billing office for a Multi-specialty Group and when reviewing the OB office charges, we have found that for the NC Global antepartum visits, the office is billing for 59400 (Routine OB Care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care.

    My co-worker and I were discussing this and we feel that billing the 59426-5946 for antepartum care and 59430 would be more appropriate for ante-, postpartum care since 59400 is strictly for vaginal delivery and 59610-59622 is for C-Section. During most antepartum visits, a physician does not know whether the patient will end up delivering vaginally or C-Section.

    Can anyone advise? I know this does not affect the physician's reimbursement as it is billed as a NC, but we would like to know we are billing correctly for proper coding.


    Heather MacPherson, LPN, CPC, CPC-H

  2. #2
    Kansas City, MO
    I have seen this handled in so many different ways, but not quite this way. The practices that I deal with use the Category II codes to track the antepartum and post partum visits as they make the most sense from a "what service was provided" stand point.

    Look at the following codes 0500F, 0502F and 0503F. These are all set up in our system as no-charge codes and it is easy to run reports. When we have to do a bill-out due to a transfer of care or a termination of pregnancy it is easy to determine what codes should be billed out.

    This is just one way to do it.
    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 No Charge OB Visits
    I believe the best way to code the no charge visits is to use the Category II Codes Listed in the CPT book. Category II CPT Codes are used for tracking certain services, their use is optional, and they are not required for correct coding and are not reimbursable. Some of our managed care programs want us to submit these codes so that they can track the number of visits. The important thing is to use the appropriate diagnosis codes on them. Often times a generic and inappropriate diagnosis code will be used on "no charge" billings.

    The codes are:

    0500F - Initial prenatal care visit (report at first prenatal encounter with health care professional providing obstetrical care. Report also date of visit and, in a separate field, the date of the last menstrual period [LMP])

    0501F - Prenatal flow sheet documented in medical record by first prenatal visit (documentation includes at minimum blood pressure, weight, urine protein, uterine size, fetal heart tones, and estimated date of delivery). Report also: date of visit and, in a separate field, the date of the last menstrual period [LMP] (Note: If reporting 0501F Prenatal flow sheet, it is not necessary to report 0500F Initial prenatal care visit)

    0502F - Subsequent prenatal care visit [Excludes: patients who are seen for a condition unrelated to pregnancy or prenatal care (eg, an upper respiratory infection; patients seen for consultation only, not for continuing care)]

    0503F - Postpartum care visit

    Using these codes help assure proper statistical reporting too. I hope this helps.
    Mickie Kummer, CPC, CPMA, CRC, CPC-I, AAPC Fellow

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