Ob-Gyn Coding Alert

Heads up:  You'll find 3 options for reporting these services

When your ob-gyn performs only the antepartum care and not the delivery, make sure you do one thing: Count the number of visits, coding experts say.

Red flag: When your ob-gyn provides only the antepartum care, you will have to abandon the global codes:

- 59400--Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care

- 59510--Routine obstetric care including antepartum care, cesarean delivery, and postpartum care

- 59610--Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery

- 59618--Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery.

CPT states that antepartum care includes monthly visits up to 28 weeks gestation, biweekly visits up to 36 weeks gestation, and weekly visits until delivery, says Peter Carraro, medical coder at Cornerstone Clinic for Women in Little Rock, Ark. Ob services include obtaining the patient's history, performing a physical exam, recording vital statistics, and doing other examinations necessary to provide safe and appropriate care for the mother and fetus.

Check These 3 Options

If your ob-gyn only provides antepartum care, you have three potential ways to report his services.
 
Option 1: -If the patient had a total of one to three antepartum visits, report the appropriate level of E/M service for each visit with the date of service that the visit occurred and the diagnosis for why the patient was seen,- states the American College of Obstetricians and Gynecologists (ACOG).

Example: If the doctor sees an ob patient twice before she moves to a different area, you would report the appropriate E/M code (99201-99215) for each visit with V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy).

Option 2: On the other hand, if the ob-gyn sees the patient four to six times before she leaves his care, you will report 59425 (Antepartum care only; 4-6 visits), ACOG states. Because 59425 represents the total work involved with all of the visits, you should submit it only once with a -1- in the units box of the CMS-1500 claim form. Best Bet: Be sure to include the -to- and -from- dates during which the services occurred.

Enter the date of the first prenatal visit in box 15, and only enter the date of the last visit the patient was seen for prenatal care in box 25a, experts say.

Option 3: If your physician provides seven or more antepartum visits, you should report 59426 (... 7 or more visits), according to ACOG. As with 59425, you should report 59426 only once and place a -1- in the units box. You should also record the -to- and -from- dates for the services your ob-gyn provided.

Tip: To avoid reimbursement hassles, be sure to ask your carriers how they want multiple antepartum visits coded, experts say. Each carrier may have different requirements for reporting services--especially those services that vary from the usual--and physicians must know how to correctly report the services they provide to be in compliance, as well as receive appropriate reimbursement for their work.

Note: Some payers may allow you to bill an E/M service instead of the antepartum visit package codes, says Emily Boyer, CPC, coding specialist at Medical Management Resources Inc. in East Syracuse, N.Y. And reporting individual visits allows you to get paid at the time of service rather than waiting until you complete the required number of visits and billing the corresponding code. -Because this varies from carrier to carrier, be sure to ask what their policy is,- Boyer says.