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OB antepartum care (Pat had only 3 regular ob visits before she delivered).

Vangie Posted Thu 26th of May, 2011 00:42:12 AM

Scenario:

03/31/11: Pat first ob visit. She was transferred from another facility at 34 weeks. I charged E/M for this initial visit based on the documentation.

04/06/11: UTI. Charged E/M.

04/12/11: REgular OB visit. No issues.
04/22/11: Regular OB visit. No issues.
04/29/11: Regular OB visit. No issues.

05/15/11: Pat Delivered here at our hospital. She was assigned 59515 (Cesarean Delivery).

For the visit on: 04/12/11, 04/22/11, 04/29/11, since there was only three Regular OB visit with No issues, do I charge these individually with appropriate E/M.

Maybe these can be bundled into the 59515 (Cesarean Delivery).

Please help?

SuperCoder Answered Thu 26th of May, 2011 03:28:00 AM

1. You could bill CPT Codes 99201 through 99215 ranges for antepartum visits 1 or 2 or 3. Bill one code per visit, but it is bundled with cesarean delivery code (59515). You could use modifier.
2. If antepartum visits 4, 5, or 6, you could bill one single code 59425 with cesarean delivery code 59515 and it is not bundled.
3. If antepartum visits 7 or more, you could bill 59426 single code with 59515 and it is also not bundled as per latest NCCI edits.

SuperCoder Answered Thu 26th of May, 2011 03:47:14 AM

As per ACOG guidelines, as the patient is transferred very late in the pregnancy, so 59515 would be enough. Had it been a transfer in early pregnancy status, then code E/M additionally.

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