# OB visit with ultrasound



## lhoot (Dec 28, 2018)

Good Morning,
I'm not that familiar with OB visit billing and could use some help.  Patient is seen for initial OB visit at 8 wks, is scheduled to come back in 2 wks for an ultrasound.  No complications, normal pregnancy.  Same physician will take care of prenatal, delivery and postpartum care. 

How is the initial visit coded?  My thought is 59400

How is the second visit for just the US coded?  My thought is 76801

If the second visit included a regular prenatal visit along with the ultrasound, how is that coded? 

Thank you in advance for all advice,
Laura


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## MrLittlefoot (Dec 28, 2018)

You wouldn't bill the global labor and delivery code(59400) until the baby is actually born. Until then, how do you know what way the baby will be delivered, or if your OB will even be available at the time of delivery? You will end up holding the bill until the patient delivers(unless they change insurance carriers mid pregnancy or chose to obtain care through another provider outside of your practice.) The global OB codes for antenatal care include all routine office visits(monthly until 28 weeks, biweekly to 36 weeks and weekly after that until delivery), routine chemical urinalysis, recording of weight, blood pressure, fetal hear tone, physical exams and history. The global code is only for complications, and doesn't include routine ultrasounds(although watch out with these, lots of carriers will only pay for one routine ultrasound per pregnancy.) For a routine prenancy ultrasound 76801 is the correct code. I found an AAPC article with some good information on the basics of coding global maternity services that i'll post the link to as well. 

https://www.aapc.com/blog/25857-from-antepartum-to-postpartum-get-the-cpt-ob-basics/


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## lhoot (Dec 28, 2018)

Thank you so much, MrLittlefoot. Your explanation of the global codes makes sense, explained the way you did.  So, if you don't code a global code until delivery, how do you code for each routine visit?

Laura


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## MrLittlefoot (Dec 28, 2018)

You actually don't bill those routine visits separately. All of those routine antepartum visits, as well as the postpartum visits, and delivery are all included in the payment for 59400(vaginal delivery) or 59510(cesarean delivery) or 59610(vaginal delivery after previous cesarean delivery) or 59618 (cesarean delivery following attempted vaginal delivery after previous cesarean delivery.) You would use one of those 4 codes assuming the patient saw your doctor for all antepartum care, the doctor delivers the baby, then allows for 6 weeks of routine postpartum care. The only way you would bill standard E/M cpt codes for routine antepartum care is if you see the patient for less than 3 visits and have no further participation in the antepartum care. Otherwise, you use the full global codes above, or 59425 for 4-6 visit, or 59426 for 7+. You would only use 59425 or 59426 if your doctor doesn't deliver the baby. There are more codes for postpartum only(59430) as well as a number of codes for doctors who only deliver the baby, but don't provide the antepartum or postpartum care. But if your doctor is doing all 3 elements of the global code, those are what you would use instead of breaking it up into partial codes or individual office visits.


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## Cmama12 (Dec 31, 2018)

lhoot said:


> Thank you so much, MrLittlefoot. Your explanation of the global codes makes sense, explained the way you did.  So, if you don't code a global code until delivery, how do you code for each routine visit?
> 
> Laura



You would use a tracking code with a 0 dollar value for all the prenatal visits. After the patient delivers, or moves, transfers to another provider, etc. you will count how many visits they had and bill accordingly.


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## lhoot (Jan 7, 2019)

Thank you so much to both of you.  You both helped considerably.  
Laura


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