# Antepartum 59425 & 59426



## 00056831 (Nov 29, 2011)

PLEASE HELP!!!! HAVE READ OTHER POSTINGS AND STILL CONFUSED.  HAVE BEEN TOLD THAT IF PHYSICIAN SEES OB PATIENT ONLY THREE VISITS THEN E&M CODES ARE USED.  
IF, HOWEVER, PATIENT IS SEEN PAST THE FIRST THREE VISITS 4-6  THEN ONLY CODE 59425 IS USED.  FURTHER VISITS, UP TO 7 OR MORE THEN ONLY 59426 CODE IS USED FOR FINAL CHARGE OF ALL ANTEPARTUM CARE...IS THIS CORRECT?  

WOULD YOU AT LEAST CHARGE AN E & M CODE FOR THE FIRST ENCOUNTER?


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## gillard10 (Nov 29, 2011)

I've just been trained in this and the first three visits you use an E/M and then visits 4-6 you use the 59425 and then 7+ you use the 59426.


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## ajs (Nov 29, 2011)

00056831 said:


> PLEASE HELP!!!! HAVE READ OTHER POSTINGS AND STILL CONFUSED.  HAVE BEEN TOLD THAT IF PHYSICIAN SEES OB PATIENT ONLY THREE VISITS THEN E&M CODES ARE USED.
> IF, HOWEVER, PATIENT IS SEEN PAST THE FIRST THREE VISITS 4-6  THEN ONLY CODE 59425 IS USED.  FURTHER VISITS, UP TO 7 OR MORE THEN ONLY 59426 CODE IS USED FOR FINAL CHARGE OF ALL ANTEPARTUM CARE...IS THIS CORRECT?
> 
> WOULD YOU AT LEAST CHARGE AN E & M CODE FOR THE FIRST ENCOUNTER?



You would charge an E/M for the first encounter if the purpose of the visit was to establish that the patient is pregnant, or if it is one of the three visits the patient is seen for and you are not using the global OB care and delivery code 59400.  If the patient comes in for a pregnancy test, brief physical exam and discussion about the next steps, that can be billed as a separate encounter.  Once a provider begins the actual prenatal care, this is included in the global package, whether it is the full OB package, or one of the antepartum care packages.  There is a complete description of these scenarios in the CPT book just prior to the OB codes that should help clarify the information for you.

P.S.  When you post questions could you take off your caplock?  It makes it appear you are shouting.  Thanks!


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## 00056831 (Nov 29, 2011)

Thank you for the information.


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## missy874 (Nov 29, 2011)

You may find this link helpful

http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=4666


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## MARCIE CPC CPB CPMA CRC (Nov 30, 2011)

Per Melanie Witt, a true coding Guru, if the visits exceed 10 with antepartum care only, you CAN append the -22 modifier to the antepartum care. I did not get the true jist of the question, but thought this information might be helpful to anyone who was searching in the future

Reference: SuperCoder.com

Good Luck

Marcie S., CPC


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