When dividing ob-gyns' roles with split antepartum care, the key is counting the visits, coding experts say.
When your obstetrician shares maternity care with a physician outside a group practice, you will have to abandon the global codes (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care; 59510, Routine obstetric care including antepartum care, cesarean delivery, and postpartum care; 59610, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care, after previous cesarean delivery; and 59618, Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery).
CPT states that antepartum care includes monthly visits up to 28 weeks gestation, biweekly visits up to 36 weeks gestation, and weekly visits until delivery, says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. Ob services include obtaining the patient's history, performing a physical exam, recording vital statistics, and doing other examinations necessary to provide safe and appropriate care for the mother and fetus.
"When patients change providers during the course of their pregnancies, the question for ob coders becomes: What options do we have in accurately coding and reporting the services provided?" Mulholland adds. 3 Choices for Coding Antepartum Care If your ob-gyn only provides antepartum care, you have three potential ways to report his services.
Option 1: "If the patient had a total of one to three antepartum visits, report the appropriate level of E/M service for each visit with the date of service that the visit occurred and the diagnosis for why the patient was seen," states the American College of Obstetricians and Gynecologists (ACOG). For example, if the doctor sees an ob patient twice before she moves to a different area, you would report the appropriate E/M code (99201-99215) for each visit with V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy).
Option 2: On the other hand, if the ob-gyn sees the patient four to six times before she leaves his care, you will report 59425 (Antepartum care only; 4-6 visits), ACOG states. Because 59425 represents the total work involved with all of the visits, you should submit it only once with a "1" in the units box of the CMS-1500 claim form. Also, be sure to include the "to" and "from" dates during which the services occurred.
Enter the first prenatal visit in box 15 and only enter the last visit the patient was seen for prenatal care in box 25a, says Brenda Dombkowski, CPC, a coding specialist at [...]