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ICD 10 Coding Alert

Reader Question:

How to Report Pregnancy Patient Transfers

Published on Tue Jan 03, 2012

Question: If a patient transfers out prior to delivery, how should I bill for all visits to date? Should I use a diagnosis other than pregnancy?California subscriberAnswer: For your CPT® code, you'll have to count the number of visits the ob-gyn saw the patient to determine the correct code. Under CPT® rules, if the ob-gyn saw her only one, two or three times, you bill each as an E/M code (99201- 99205 for new patients, 99211-99215 for established patients).If the ob-gyn saw her four to six times, you bill 59425 (Antepartum care only; 4-6 visits) instead. If the ob-gyn saw her seven or more times before the transfer, you should bill 59426 (... 7 or more visits) instead. But look at what the payer wants because its guidelines may be different from CPT® rules.Currently, you should use the diagnosis that represents each E/M visit (pregnancy or pregnancy complication), and if [...]
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