Do you think it makes sense how cpt has codes for each type

Reference no: EM133371594

Case Study: When you are coding for an OB doctor, each OB patient has a story! Since you code the entire Prenatal care, Delivery and Postpartum check all at once you must be certain this patient has seen your physician for the entire course of care for this pregnancy. It is easy to code a patient who has seen the same doctor for all of her care including delivery. For a vaginal delivery use code 59400 (total OB care), for a C-section use 59510 and for a VBAC (Vaginal birth after previous cesarean) use 59610.

However, when researching the patient's chart, a coder may find the patient did not have the same OB/Gyn for the entire pregnancy. Perhaps the patient has moved to town and saw another OB for a few prenatal visits and is now coming to your OB doctor for the duration of her pregnancy. Or perhaps, your doctor will not be available to deliver the baby and his colleague will only bill the Delivery portion and your doctor will bill the rest of this patient's care.

The CPT book allows for these scenarios, and by utilizing the appropriate codes, each physician involved in a patient's care can and will be able to bill appropriately (with your help, of course!)

Let's look at a scenario just for fun! Sally Jones will be the name of our patient!

Sally moved to Wichita, Kansas from Houston, TX. Sally was 5 months pregnant with her third child, and while in Houston, received care from Doctor Allen. She saw Dr. Allen for 4 prenatal appointments. She then came to Wichita, KS and received the rest of her prenatal care (9 more prenatal appointments) from Dr. Brown. When Sally went into labor, Dr. Brown was out of town, so his colleague, Dr. Cullen delivered the baby. When Sally went in for her six-week postpartum check, she saw Dr. Brown and received a good report and was able to go back to working as an ambulatory coder at the ASC in her hometown!

So, who bills what?

Well, Dr. Allen had 4 prenatal appointments, so he should bill the antepartum care he did. This would be code 59425 (Antepartum care only; 4-6 visits) with a diagnosis code from category Z34 (Routine prenatal care).

Dr. Brown saw her for 9 prenatal visits and her postpartum check. So, for the antepartum care he would bill code 59426 (7 or more visits) with the diagnosis code from category Z34, as well as 59430 (postpartum care only) with diagnosis code from category Z39 (postpartum care). Although this code (59430) states it is a separate procedure, this is what it is for and is the only code to use in this situation.

Dr. Cullen did the vaginal delivery and no complications were mentioned so he would bill 59409 (vaginal delivery only) with the appropriate diagnosis codes (the coder would check the Labor and Delivery record from the hospital to ensure adequate diagnosis coding).

A few other rules to keep in mind. If a patient only sees a doctor for 1-3 antepartum visits (perhaps a miscarriage or other circumstance arises) the coder must use the appropriate E/M office visit codes to report these visits.

Also, the amount of prenatal visits ranges from 12-16 visits for one patient, depending on their insurance. If a patient sees a physician for more than 16 visits and any of the visits are not for routine prenatal checks (i.e.: the patient is having severe headaches) you may bill for any visits outside of the usual 16 visits, utilizing the appropriate E/M code and the appropriate diagnosis code (i.e.: R51 - for the headache rather than Z34) for these additional visits. You may want to check with your doctor before billing these additional visits, as some docs do not want to bill their patient's for these services separately.

Utilize your CPT book and all codes available when billing Maternity Care and Delivery and you'll do just fine!

Questions: Post the answers to the following questions via this discussion forum:

Do you think it makes sense how CPT has codes for each type (vaginal, cesarean, VBAC) of delivery? Why or why not?
In your CPT code book, read the informative paragraphs under the Maternity Care and Delivery section describing what is included in the Maternity Care and Delivery services. Notice how this information details coding guidelines for various scenarios. The first paragraph states, "Pregnancy confirmation during a problem oriented or preventive visit is not considered part of the antepartum care and should be reported using the appropriate E/M service codes 99201, 99202, ...". Does this make sense to you? Why or why not?

Reference no: EM133371594

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