Ask an Expert

Answers to Compliance and Medical Coding Questions.
  1. Tammy Posted 2 month(s) agoRelated Topics

    Hello, what would be the appropriate dx code for an OB referral for C/section. Provider: Pt here today for RLTCS referral. Pt states she is taking her PNV daily and baby is moving normally. Pt states that they were planning on vasectomy and IUD till he is able to have vasectomy completed. Pt given information on pricing for Tubal. Pt would like to proceed with RLTCS with BTL. Will plan for 39wks. please let me know so I can bill an office visit for this provider. thank you.

  2. SuperCoder Posted 2 month(s) ago

    Hi,

    You can bill ICD 10 code O34.21- (Maternal care for scar from previous cesarean delivery) as patient had previous C section. 

    Thanks

  3. Tammy Posted 2 month(s) ago

    I meant can we bill an E/M ( antepartum visit) since another provider is doing the ob care( will be billing global) not the consult visit. thanks.

  4. Tammy Posted 2 month(s) ago

    Please let me know on this.

  5. SuperCoder Posted 1 month(s) ago

    Hi,

    Yes you can bill.

    Global OB codes are utilized when the Same Group Physician and/or Other Health Care Professional provides all components of the OB package. However, physicians from different group practices may provide individual components of maternity care to a patient throughout a pregnancy. Although Obstetric (OB) Related E/M Services should be billed as a global package,
    itemization of Obstetric (OB) Related E/M Services may occur in the following situations:

    •  A patient transfers into or out of a physician or group practice
    • A patient is referred to another physician during her pregnancy
    • A patient has the delivery performed by another physician or other health care professional not associated with her physician or group practice
    • A patient terminates or miscarries her pregnancy
    • A patient changes insurers during her pregnancy
    1.  Antepartum Care Only

    The CPT Editorial Board created codes 59425 (Antepartum care only; 4-6 visits) and 59426 (Antepartum care only; 7 or more visits) to accommodate for situations such as termination of a pregnancy, relocation of a patient or change to another physician. In these situations, all the routine antepartum care (usually 13 visits) or global OB care may not be provided by the Same Group Physician and/or Other Health Care Professional.The antepartum care only CPT codes 59425 or 59426 should be reported by the Same Group Physician and/or Other Health Care Professional when:

    The antepartum care provided does not meet the routine antepartum care definition of the global OB package as defined by CPT ; or
     The antepartum care provided is less than the typical number of visits (usually 13) during the
    global OB package as defined by ACOG.
    If the patient is treated for antepartum services only, the physician and/or other health care professional should use CPT code 59426 if 7 or more visits are provided, CPT code 59425 if 4-6 visits are provided, or itemize each E/M visit if only providing 1-3 visits. 

    Hope that helps!

About this Question

  • Posted by 27950 Tammy, 2 month(s) ago. There are 5 posts. The latest reply is from SuperCoder.