Wiki E&M vs. 59425

[minoweka]

59425 Antepartum Care Only: 4-6 visits.
Excludes: Antepartum Care, 1-3 visits (99201-99499[99224,99225,99226])

My understanding is that once you meet the threshold of 4 visits, the following is true:

A. Billing the 1st thru 3rd antepartum visits with an E&M code is no longer an option

B. 59425 includes all antepartum visits thru the 6th visit.

Is my understanding correct?

Thank you
Dorothy CPC-A

 

[andyrobin]

E/M vx 59425

Yes, that is correct. If the patient has had 4 - 6 visits and she is no longer seeing your provider for the pregnancy, you charge 59425.

 

[minoweka]

Thank you Robin

 

[TYSON1234]

Can somebody tell me where to find this new information about not being able to bill ob visits 1-3 with an E/M.

Thnaks again, Jennie

 

[minoweka]

Hi Jennie,

You can bill visits 1, 2 and 3 with an E&M. Once you have a 4th (thru 6th) pre-natal visit, cpt code 59425 is appropriate. These codes, conventions are not applicable until after the delivery, (provider did not deliver baby) so you know exactly the number of pre-natal visits to code for when you review the patient encounters.

Dorothy P
CPC-A