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antepartum care over 13 visits?

Susan Posted Tue 21st of February, 2017 17:57:06 PM
If we see a patient for more than 13 visits due to hypertension or diabetes, etc how can we bill the extra visits? Do we have to bill specific visits where these are discussed or just the last visits over 13? I've tried adding modifier -25 and been denied as included in global. Also adding -22 to the global is just ignored.
SuperCoder Answered Wed 22nd of February, 2017 07:34:33 AM



The reason for your denial could be the inappropriate diagnosis code billed along with the E/M service.


In pregnancy, there is a condition known as Preeclampsia (a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine) and gestational diabetes (condition in which a woman without diabetes, develops high blood sugar levels during pregnancy).

CPT code 59426 can be billed for antepartum care. As per Medicare, antepartum care comprises of the following visit schedule.

It includes monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery. 59426 covers seven or more visits.



There may be chances that both these symptoms are addressed in your visit, hence, you are advised to append appropriate diagnosis code for preeclampsia and gestational diabetes in order to prevent denial.


Your medical records should clearly explain the need for the E/M service with proper documentation.



Hope that helps!



Thank you!!

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