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Antepartum 59425 & 59426

  1. Question Antepartum 59425 & 59426
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    PLEASE HELP!!!! HAVE READ OTHER POSTINGS AND STILL CONFUSED. HAVE BEEN TOLD THAT IF PHYSICIAN SEES OB PATIENT ONLY THREE VISITS THEN E&M CODES ARE USED.
    IF, HOWEVER, PATIENT IS SEEN PAST THE FIRST THREE VISITS 4-6 THEN ONLY CODE 59425 IS USED. FURTHER VISITS, UP TO 7 OR MORE THEN ONLY 59426 CODE IS USED FOR FINAL CHARGE OF ALL ANTEPARTUM CARE...IS THIS CORRECT?

    WOULD YOU AT LEAST CHARGE AN E & M CODE FOR THE FIRST ENCOUNTER?

  2. Default
    I've just been trained in this and the first three visits you use an E/M and then visits 4-6 you use the 59425 and then 7+ you use the 59426.

  3. #3
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    Quote Originally Posted by 00056831 View Post
    PLEASE HELP!!!! HAVE READ OTHER POSTINGS AND STILL CONFUSED. HAVE BEEN TOLD THAT IF PHYSICIAN SEES OB PATIENT ONLY THREE VISITS THEN E&M CODES ARE USED.
    IF, HOWEVER, PATIENT IS SEEN PAST THE FIRST THREE VISITS 4-6 THEN ONLY CODE 59425 IS USED. FURTHER VISITS, UP TO 7 OR MORE THEN ONLY 59426 CODE IS USED FOR FINAL CHARGE OF ALL ANTEPARTUM CARE...IS THIS CORRECT?

    WOULD YOU AT LEAST CHARGE AN E & M CODE FOR THE FIRST ENCOUNTER?
    You would charge an E/M for the first encounter if the purpose of the visit was to establish that the patient is pregnant, or if it is one of the three visits the patient is seen for and you are not using the global OB care and delivery code 59400. If the patient comes in for a pregnancy test, brief physical exam and discussion about the next steps, that can be billed as a separate encounter. Once a provider begins the actual prenatal care, this is included in the global package, whether it is the full OB package, or one of the antepartum care packages. There is a complete description of these scenarios in the CPT book just prior to the OB codes that should help clarify the information for you.

    P.S. When you post questions could you take off your caplock? It makes it appear you are shouting. Thanks!
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  4. Default Antepartum 59425 & 59426
    Thank you for the information.

  5. #5
    Default
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  6. Smile
    Per Melanie Witt, a true coding Guru, if the visits exceed 10 with antepartum care only, you CAN append the -22 modifier to the antepartum care. I did not get the true jist of the question, but thought this information might be helpful to anyone who was searching in the future

    Reference: SuperCoder.com

    Good Luck

    Marcie S., CPC

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