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Antepartum Care

  1. #1
    Default Antepartum Care
    Medical Coding Books
    Hi all--

    Would the initial visit for a known pregnancy be coded as one of the E/M code ranges 99201-99499? Can 59425 (Antepartum care only; 4-6 visits) and 59426 (Antepartum care only; 7 or more visits) be coded as the initial visit if they visit an OB/GYN?



  2. #2
    Thoughts anyone?

  3. Wink
    If the initial visit was billed as an E&M it is not part of the global package,
    since it is coded as GYN.

  4. #4
    Glendale AZ
    the first visit can be billed seperate from the global package ONLY if flowsheet was not started. Once the flowsheet is started you use the antepartum/global codes.

    Traci, CPC

  5. #5
    Thanks to you both for a reply. I was beginning to think no one would

    Anyways, would the antepartum codes be billed only if this was an encounter that resulted in an inpatient stay? I was wondering about a regular office visit to her OB/GYN or her PCP. Would these visits be continually billed out as an E/M visit or as one of the antepartum codes? Thanks!


  6. #6
    By "regular office visit," do you mean visits for routine PN care or visits for a non-OB problem or OB complication? Is your doctor doing the delivery?

    Becky, CPC

  7. #7
    Quote Originally Posted by bonzaibex View Post
    By "regular office visit," do you mean visits for routine PN care or visits for a non-OB problem or OB complication? Is your doctor doing the delivery?

    Becky, CPC
    Hi Becky-

    I mean routine PN care for the pregnancy. No complications or non-OB problems and I'm not sure if the doctor would be doing the delivery---Does this also matter in the choice of codes?


  8. #8
    If your doctor does the delivery, then you're not going to bill out separately for the routine antepartum care. If you are unsure about who is doing the delivery, then you need to "wait and see." The global OB codes (59400, 59510, 59610, 59618) includes the PN care. Carriers will routinely deny any antepartum services billed before delivery because they assume they will be getting a claim for the global.

    If you know your doctor is not doing the delivery, but s/he is doing some routine PN care (which may be the case if the patient is delivering with a mid-wife) you still need to wait until delivery to bill out the visits. Your end code (59425, 59426) is going to depend on the number of visits provided before delivery.

    Does that help? Let me know if it doesn't make sense....


  9. #9
    Hi Becky-

    I think I understand what you are trying to explain here. Let me just see if I got this straight:

    So throughout the pregnancy, each time the patient goes into see her OB for her routine prenatal care, none of these visits are actually billed until after she delivers? If the OB doctor that the patient has been seeing for all her prenatal care was the one who delivered the baby then this physician would bill one of the codes 59400, 59510, 59610, or 59618?

    And if a different doctor did the delivering then the doctor who did the delivery would bill only the delivery codes + postpartum care if appropriate and the OB doctor who the patient has been seeing for all her prenatal care would only bill one of the antepartum care codes 59425 or 59426 depending on the number of visits provided before delivery?

    I probably just re-instated what you said but rewriting it sometimes helps it sank in better, so please just confirm if my thoughts are correct on this one. Thanks!!

  10. #10
    Exactly! :-)

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