Ob-Gyn Coding Alert

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 subscriber


Answer: 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. 

You use the diagnosis that represents each E/M visit (pregnancy or pregnancy complication), and if billing the series of antepartum visits, add the codes that describe any complications. If none, then use just V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy).