# last OB visit same day as delivery ... need help



## debellis59 (Jan 6, 2015)

Patient comes in for OB visit and later that day went into labor and delivered.  The antepartum care was not enough for global.  How do I bill the antepartum care in this case?  If I can use the office visit that day, which modifier do I use?  This is the difference between the antepartum care being 59425 and 59426.

Any help you can offer would be appreciated.


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## Lashel (Jan 6, 2015)

I just want to make sure I understand correctly before I try to answer. Your physician did not deliver the baby? Assuming your physician did not do the delivery, then I would select the antepartum care only code that represents the number of antepartum visits you provided including the last one on the day of delivery. Here is a snippet from CPT assistant with regards to the global if your physician did deliver. Maybe it will help. 

Use codes 59400 and 59510 when one physician or physician group practice provides all obstetric care, since third-party payors have differing requirements. The number of antepartum visits a patient is allowed varies, depending on when she enrolls for antepartum care and when she delivers. Typically, if a patient enrolls in the early first trimester and delivers at term, she will have approximately 13 antepartum visits. However, even if a patient delivers prematurely and the appropriate number of antepartum visits have been scheduled, as defined by CPT, the definition of global service has been met. 

If a patient is seen more frequently than defined by CPT (eg, a patient develops hypertension at 32 weeks of gestation and must be seen weekly rather than biweekly), the global service is reported, up to and including 13 visits. If the total number of antepartum visits exceeds 13 because of a high-risk condition, the additional visits may be reported using the E/M codes for each additional visit. 

Patients enrolling for antepartum care late in their pregnancy may require more intensive management over fewer visits, to the point that the level of care matches or surpasses that given to a typical obstetric patient. Although you should consider these situations individually, it is usually appropriate to report the global package codes for patients enrolling late for obstetric care provided by the same physician or physician group. When appropriate, you may use the -52 modifier to indicate reduced services. 


Lashel , CPC CPC-I CEMC CPPM


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## debellis59 (Jan 6, 2015)

Thank you for your response.  Our doctor *did* deliver the baby.  But, she was seen earlier in the day for her regular visit by him.  She didn't have any antepartum complications, she had transferred her care to us after moving to the area.  I am just wondering, because I keep thinking this happened years ago when I was just starting OB coding, whether I could bill the antepartum care using that date of service and, if so, what modifier would I want to use.

It seems to me that when this happened years ago in the little town I came from that I couldn't bill the antepartum for the same DOS as the delivery witout a modifier.  She was not in labor (no note of any contractions) when she came in for her visit earlier in the day.  She had 6 visits prior to the day she came in for her last visit (and then later delivered) ... and THAT day made 7 visits.  The difference between 59425 and 59426.


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## gena379 (Jan 12, 2015)

I've billed the 59425/59426 on same date as delivery and haven't had any problems.


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