Avoid Leaving Split Antepartum Care Dollars On The Table

If you ob-gyn's providing only one-two visits, here's what you should submit.

When it comes to coding split antepartum visits, do not shortchange your practice. Depending on the number of visits your ob-gyn provides, you'll report either an evaluation & management visit or one unit of an antepartum visit code. Take this challenge and see how you fare:

Question 1: Establish antepartum care definition

According to CPT, antepartum care is inclusive of monthly visits up to 28 weeks gestation, bi-weekly visits up to 36 weeks gestation, and weekly visits until delivery.

Answer is true. Ob services include obtaining the patient's history, carrying out a physical exam, recording vital statistics, and doing other examinations required to provide safe and proper care for the mother and fetus.

Question 2: Splitting visits mean no global is it?

When you split out antepartum care for a patient halfway through her pregnancy, you should totally throw out global ob package codes.

Answer is true.

When your obstetrician shares routine maternity care with a doctor outside a group practice owing to transferring into or out of your practice, you'll have to get rid of the following global codes: 59400, 59510, 59610 and 59618.

Don't break the package just because a maternal fetal specialist also tends to the patient for a few visits during pregnancy owing to complication.

Question 3: Depend on evaluation & management code for this number of visits

If the patient had a total of one to three antepartum visits, report the proper level of evaluation & management service for each visit when the DOS that the visit took place and the diagnosis for why the patient was seen.

The answer is true. This is correct as per the American Congress of Obstetricians and Gynecologists (ACOG) and CPT guidelines.

For instance, if the physician sees an ob patient a couple of times prior to moving to a different area, you would use the proper E/M code (99201-99215) for each visit with V22.0 or V22.1.

Question 4: Be careful of your antepartum visits

If the ob-gyn tends to the patient four to six times prior to leaving his care, you'll report 59425 for each instance the ob-gyn sees the patient.

The answer is false. You should use 59425 one time only. Since this code represents the total work involved with all the visits, you should submit it only once with '1' in the units box of the CMS-1500 claim form. What's more, be sure to include the 'to' and 'from' dates during which the services took place. Enter the first prenatal visit in box 15 and enter only the last visit the patient was seen for prenatal care in box 25a.