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59425 and 59426-get some clarification

  1. Default 59425 and 59426-get some clarification
    Medical Coding Books
    Trying to just get some clarification on the two codes.

    Our situation;

    A patient transfers to us (we did not do initial care) lets say we see the patient 5 times before actual delivery, we do the delivery and bill 59410 (delivery including postpartum care) do we then also bill 59425 for the 5 visits or are these billed seperatly as each visits occurs.

    My confusion I guess is that reading about 59425 and 59426 it sounds like these two codes are ONLY used if our doc does not do the delivery.

    Any help is appreciated

  2. #2
    The 59425 & 59426 are used if you cannot bill a global OB code for whatever reason. Transfer of care would be one of those reasons--the originating OB doc gets to bill out for the portion of care that s/he provided, and you get to bill out for the portion of care your doc provided.

    In your situation above, you would bill out the 59425 as one line item, one unit, using the last date seen as the DOS. This one code will garner reimbursement for your 5 visits. You bill for the 59410 separately. The POS on the 59425 will be Office, and the POS on the 59410 will be IP Hosp.

    Becky, CPC

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