Correct Coding for Level of Maternity Care Provided
Published on Tue Feb 01, 2000
Depending on whether a family practitioner provides antepartum care only, delivers the baby, just offers postpartum care or does a combination of all three changes the coding picture. Codes also depend on how much antepartum care is provided and on the type of deliveryvaginal, cesarean or vaginal after a previous cesarean delivery.
To provide an idea of what is possible in the scope of a family practice, consider the following:
A family practitioner (FP) provides antepartum care for three visits, turns the delivery over to an ob/gyn but oversees the postpartum care for his established patient, a 30-year-old first-time mother with slightly high blood pressure. The FP would code 99212 (office or outpatient visit for the evaluation and management of an established patient, with a problem focused history, a problem focused examination and straightforward medical decision making) or a higher level evaluation and management (E/M) code, if there were any complications, for each of the three visits and 59430 (postpartum care only [separate procedure]).
Greg Schnitzer, RN, CPC, CPC-H, CCS-P, audit specialist with the office of audit and compliance with the University of Pennsylvania in Philadelphia, says that confusion may arise if the ob/gyn uses a global obstetric care code, 59400 (routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy and/or forceps] and postpartum care), even though he or she only did the delivery, not the ante- or postpartum care. Then there would appear to be a duplication of services between the family practitioner and the ob/gyn.
A patient sees her family practitioner five times prior to the birth of her baby and again for postpartum care. This time the family doctor would bill 59425 (antepartum care only; 4 to 6 visits), along with 59430 for the postpartum care. If she had made seven or more antepartum visits, 59426 (antepartum care only; 7 or more visits) would be used instead of 59425.
The American College of Obstetricians and Gynecologists (ACOG) says, however, that if the total number of antepartum visits exceeds 13 due to a high-risk condition, the additional visits may be reported using E/M visits, e.g., 99212, added onto 59426 for each extra visit.
Is 59400 the Only Code to Use for Global Services?
If the family practitioner provides the ante- and postpartum care, along with a vaginal delivery, he or she simply codes for global maternity care 59400. That will include an unlimited number of antepartum care visits.
That would seem simple enough but Jean Ryan, CPC, billing compliance analyst for MeritCare Medical Center in Fargo, N.D., begs to differ. Responsible to several carriers, including Medicaid and Medicare, Ryan finds herself coding different ways for basically the same procedures depending on the carrier.
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