Wiki collegial support needed!

[LauraNewYork]

I work in a facility that provides prenatal and postpartum care, but does not do deliveries.

Problem: I have a non-coder administrator who insists that the first three global routine OB visits should be billed with 050_F and an E&M code. My understanding is that once the prenatal flowsheet starts, only the global code is used, unless the patient comes in with a complication in which case an E&M code without the global code (050_F) is used. E&M codes are only used when a routine OB patient is seen for a total of 1, 2 or 3 visits during the entire pregnancy.

Please reply to this post with:

1. The administrator is correct.
2. The CPC (me) is correct.

Any comment or guidance is always appreciated!

Laura

 

[jmpowell589]

You are correct

I believe you are correct if it is commercial insurance. Once prenatal visits start you should used 0502F. Then at the end of pregnancy bill the prenatal package cpt based on the amount of prenatal visits. 59425 4 to 6 visits or 59426 7 or more visits. Then 59430 for postnatal care only. If it were to be billed as your admin says then the insurance company may come back and recoup money from the E/Ms or possibly deny or only partially reimburse the package billed at end of pregnancy.

Hope this helps. I have been in the same situation before...