Ob-Gyn Coding Alert

A patient had received a total of seven visits, before transferring out of your practice at 27 weeks gestation. Assuming they would they would not see the patient again the practice billed the insurance company using CPT code 59426 (antepartum care; 7 or more visits). At 36 weeks gestation, the patient returned to your practice to deliver her baby and receive postpartum care.

There are essentially two ways of handling a situation such as this.

1. Refund for 59426 and then Bill for Global. Give the refund for 59426 (antepartum care; 7 or more visits) and then bill for global with the -52 modifier. Eventually, you will get paid for the global care, but that depends on the expedience with which the carrier pays out. Using this option, CPT code 59400 (for routine antepartum care with vaginal delivery, including postpartum care) would apply with the -52 modifier.

Note: Code 59400 is used for global care with vaginal delivery with no history of cesareans; consult your CPT guide for other applicable codes.

The corresponding ICD-9-CM codes for diagnosis, barring complications in the pregnancy, are: V22.0 (supervision of normal first pregnancy), or V22.1 (supervision of other normal pregnancy).

For delivery with these options, barring complications, the ICD-9-CM diagnostic code is: 650 (normal delivery). An additional code is needed for outcome of delivery. In cases of normal, single birth, the code is V27.0 (single liveborn).

2. Billing for Delivery and Postpartum Only. Treat the situation as simply as possibleas a patient who left and came back. If the patient came back for delivery and postpartum care only, bill using the appropriate CPT code depending on the circumstances of the delivery (59410 for vaginal delivery only including postpartum care).

The corresponding ICD-9 codes remain the same. The codes for postpartum care and examination are V24.0 (immediately after delivery), or V24.2 (routine postpartum follow-up).

Thomas Kent, CMM and Principal of Kent Medical Management in Dunkirk, Maryland, recommends option two. The most straightforward way of handling the situation, recommends Kent, is to treat the case as two separate cycles of treatment, because thats really what they are.

Kent advises that when in doubt, call the insurance company and find out how they want to handle the case. If the practice chooses to refund for 59426 and then bill for global, the practice should bill and receive payment for global prior to issuing the refund for 59426. But my preference, says Kent, would just be to treat the case as two separate visits. If a lot of explanation is required, Id force the case to paper and send a detailed cover letter explaining the situation.