Ob-Gyn Coding Alert

Is your ob-gyn providing only 1-3 visits? Here's what you should submit.

Don't shortchange your practice when it comes to coding split antepartum visits. Depending on the number of visits your obgyn provides, you will report either an E/M visit or one unit of an antepartum visit code. Take this four--question true/false challenge to see how you fare

Question 1: Determine Antepartum Care Definition

True/False: 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.

Solution: True, says Pat Larabee, CPC, CCP-P, coding specialist for Intermed in South Portland, Maine. 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.

Question 2: Does Splitting Visits Mean No Global?

True/False: When you split out antepartum care for a patient halfway through her pregnancy, you should completely throw out global ob package codes.

Solution: True. When your obstetrician shares routine maternity care with a physician outside a group practice due to transferring into or out of your practice, you will have to abandon the following 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 ante-partum 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.

Do not break the package just because a maternal fetal specialist also sees the patient for a few visits during the pregnancy as a result of a complication.

Bottom line: "Once you are splitting the global package into pieces, you would not go back and use a global code for any portion of the obstetrical care," says Arlene Smith, CPC, insurance specialist at Tacoma Women's Specialists in Washington. "Of course, there is always a possibility of a particular insurance carrier wanting something different, so always check to see what codes the carrier wants to report the care."

Question 3: Rely on E/M Code for This Number of Visits

True/False: 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.

Solution: True. This is correct according to the American Congress of Obstetricians and Gynecologists (ACOG) and CPT guidelines.

For 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), Smith says.

Question 4: Be Watchful of Your Antepartum Visits

True/False: If the ob-gyn sees the patient four to six times before she leaves his care, you will report 59425 for each instance the ob-gyn sees the patient.

Solution: False, Smith says. "You should report 59425 one time only."

Because 59425 (Antepartum care only; 4-6 visits) represents the total work involved with all the visits, you should submit it only once with a "1" in the units box of the CMS-1500 claim form. Also, be sure to include the "to" and "from" dates during which the services occurred. Enter the first prenatal visit in box 15 and only enter the last visit the patient was seen for prenatal care in box 25a.

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

Add This Best Advice to Your Coding Practices

To avoid reimbursement hassles, be sure to ask your carriers how to code multiple antepartum visits. 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 compliant and to receive appropriate reimbursement for the services provided. "I have to stress that you must find out what the patient's insurer wants in order to bill these services and avoid denials," Larabee says.

Some payers may allow you to bill an E/M service instead of the antepartum visit package codes. 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 bill the corresponding code.

ICD-10: When your diagnosis code system changes, you'll have new options for those codes mentioned in this article:

Code V22.0 expands into four options: Z34.00 (Encounter for supervision of normal first pregnancy, unspecified trimester), Z34.01 (... first trimester), Z34.02 (... second trimester), Z34.04 (... third trimester).

Code V22.1 will include the four new codes listed above as well as four more: Z34.80 (Encounter for supervision of normal pregnancy, unspecified, unspecified trimester), Z34.81 (... first trimester), Z34.82 (... second trimester), and Z34.83 (... third trimester).