Ob-Gyn Coding Alert

Question: When reporting 59425 and 59426, should I use delivery or antepartum ICD-9 codes when billing globally?

Iowa Subscriber

Answer: If you submit 59425 (Antepartum care only; 4-6 visits) and 59426 (... 7 or more visits), your diagnosis code's fifth digit is critical. If you bill 59425 or 59426 for antepartum care, the ICD-9 code must have a "3" as the fifth digit, for example, 651.03 (Twin pregnancy; antepartum condition or complication).

You should not use a fifth digit indicating delivery, such as "1," "2" or "4," because by definition, the ob-gyn provided the service before delivery. When you report the delivery code, then the fifth digit -- assuming you are not merely using 650 (Normal delivery) and V27.0 (Single liveborn) -- should be either "1" or "2."

Of course, if you bill the total global service (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care), you would only use a delivery fifth digit because most payers will not allow you to submit the complete service until after delivery.