Ob-Gyn Coding Alert

Question: We have a pregnant patient at 28 weeks who transferred to our ob-gyn. Can I bill the initial visit for the first time the ob-gyn sees her?

California Subscriber

Answer: You should bill the number of antepartum visits your ob-gyn sees her for, prior to delivery. This will be 59425 (Antepartum care only; 4-6 visits) or 59426 (... 7 or more visits). These two codes include your initial visit, valued as a level-five new patient service under the Resource-Based Relative Value Scale (RBRVS) system.

If, however, your ob-gyn sees the patient only three times prior to delivery or your payer requires itemization of each visit, you should report each visit separately.

You won't have a set E/M code for the patient's first and only visit. Your patient could be new to the practice, or the first visit may meet the criteria for a level-five established visit. Therefore, you should look to the entire code series (99201-99205 for new patients, 99211-99215 for established patients) as possible options.

For the second and third visit routine visits, you may be reporting 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) in the absence of documented problems, but some physicians document these visits as level two services.

Best bet: Be sure you have the documentation to back you up before assigning the level of service.