icd-10 code for antepartum care only

How do you bill antepartum care only?

If the patient is treated for antepartum services only, the physician should use CPT code 59426 if 7 or more visits are provided, CPT code 59427 if 4-6 visits are provided, or each E/M visit if only providing 1-3 visits.

What is the ICD 10 code for prenatal care?

Encounter for supervision of normal pregnancy, unspecified, unspecified trimester. Z34. 90 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z34.

How do you code antepartum?

If the patient is treated for antepartum services only, the physician should use: CPT code 59426 if 7 or more visits are provided. CPT code 59425 if 4-6 visits are provided.May 23, 2018

What care is included in antepartum care?

Antepartum care includes the initial prenatal history and examination, subsequent prenatal history and examinations, recording of weight, blood pressures, fetal heart tones, routine chemical urinalysis, and monthly visits up to 28 weeks' gestation; biweekly visits to 36 weeks' gestation; and weekly visits until ...Jul 14, 2019

What does antepartum care mean?

Antepartum care, also referred to as prenatal care, consists of the all-encompassing management of patients throughout their pregnancy course. Antepartum care has become the most frequently utilized healthcare service within the United States, averaging greater than 50 million visits annually.Nov 2, 2021

What is Primigravida antepartum?

Background: The elderly primigravida is defined as a woman who goes into pregnancy for the first time at the age of 35 years or older. Progressively, this has become more common in our contemporary society and traditionally such pregnancy is regarded as high risk.

When should modifier 22 be used?

Modifier 22 is used for increased procedural services and demonstrates when a physician has gone above and beyond the typical framework of a particular procedure.

When dealing with antepartum care what should you do if the patient only sees your particular physician for 3 or fewer visits?

If only one to three antepartum visits were provided, report the appropriate E/M codes, according to CPT® guidelines. For example, a provider performs one antepartum visit to an established patient.Aug 1, 2013

What is included in CPT code 59430?

CPT® 59430 in section: Vaginal Delivery, Antepartum and Postpartum Care Procedures.

What is the difference between antepartum and intrapartum?

Authors have distinguished between antepartum stillbirths (those occurring prior to labor), and intrapartum stillbirths (those occurring after the onset of labor) 2.Dec 31, 2010

What does CPT code 59409 include?

CPT® Code 59409 in section: Vaginal delivery only (with or without episiotomy and/or forceps)

What is intrapartum care?

It focuses on women who give birth between 37 and 42 weeks of pregnancy ('term'). The guideline helps women to make an informed choice about where to have their baby. It also aims to reduce variation in areas of care such as fetal monitoring during labour and management of the third stage of labour.Dec 3, 2014

When should a low risk pregnancy be billed with a package code?

If there was no pre-defined high-risk diagnosis, then the termination of pregnancy date should be used as the end date/delivery date.This low risk pregnancy may be billed with a package code if four or more visits were completed before the termination.If less than four visits were provided an E/M code can be billed for each visit.

What is the code for rhogamand 17p?

If RhoGamand 17P are administered during a routine prenatal visit, then the agency may bill the therapeutic injection code (96372) and the HCPCS code for RhoGam[RhoGam(J2790-full dose or J2788 -partial dose) or 17P CPT code for Makena (Q9986) –Brand new guidance as of 07/2017 or CPT code for Compound (Generic) Q9985 –Brand new guidance as of 07/2017

Can 17P be billed to a patient?

For LHDs that do not provide prenatal care or are not the assigned PMH, but administer 17P by physician order, services delivered may be billed.The 17P medication cannot be billed to the patient or third-party payor if received free by the LHD.Only bill for 17P if the agency is purchasing the medication.

What is the code for antepartum care?

The following are guidelines from the American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA) for antepartum care only code 59425 or 59426:

What is the CPT code for antepartum?

If the patient is treated for antepartum services only, the physician should use: CPT code 59426 if 7 or more visits are provided. CPT code 59425 if 4-6 visits are provided. An evaluation/management visit code for each visit if only providing 1-3 visits.

What is the global code for postpartum care?

If the provider is not claiming the global maternity package, and is providing postpartum care only, report 59430 Postpartum care only (separate procedure).

What is the average number of antepartum visits?

In most circumstances, the average number of antepartum visits for uncomplicated care is 13.

What is the code for delivery only?

If a provider performs the delivery only, and provides no antepartum or postpartum care, code selection depends on the type of delivery:#N#59409 Vaginal delivery only (with or without episiotomy and/or forceps)#N#59514 Cesarean delivery only#N#59612 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps)#N#59620 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery#N#Because delivery only is performed, and the provider is not performing the entire global maternity package, any inpatient E/M visits related to the delivery are separately reported.#N#Example: A patient presents to the hospital at 39 weeks gestation in the early onset of labor. The patient delivers a fe-male infant vaginally with the help of her primary obstetrician/gynecologist (OB/GYN). The patient develops a third-degree vaginal laceration during the delivery that is repaired by the OB/GYN. In total, the patient’s OB/GYN performs 14 antepartum visits, the delivery, and all postpartum care.#N#To correctly report this scenario, the physician will report 59400-22 for the global maternity care. Repair of minor vaginal lacerations are included in the delivery, but extensive lacerations may be reported by appending modifier 22 to the global code. In this case, the patient developed a third-degree laceration, which is considered major.#N#If a provider assists the patient’s primary OB/GYN with the delivery, and is claiming no antepartum or postpartum care, report the appropriate delivery-only CPT® code and append modifier 80 Assistant surgeon.#N#Example: Dr. A is the patient’s primary OB/GYN. The patient presents to the hospital in labor. The delivery appears to be complicated. Dr. B, who is on call with the hospital, is called in to assist Dr. A. The patient delivers a health baby girl via VBAC. Because Dr. B only assisted with the delivery (she provided no antepartum care and Dr. A is providing all postpartum care), her services are reported with 59612-80.#N#If the provider performs the delivery and also plans to provide postpartum care (but he or she did not provide any ante-partum care), CPT® specifies the following codes, based on the type of delivery:#N#59410 Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care#N#59515 Cesarean delivery only; including postpartum care#N#59614 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care#N#59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care#N#Example: A patient delivers a male infant via cesarean. The patient does not have a primary OB/GYN and has had no antepartum care. The physician performs the cesarean and orders the patient to follow up in his office for postpartum care in two weeks, which the patient does. To correctly code this encounter, the physician reports 59515.

How long does postpartum care last?

Per ICD-9-CM guidelines, postpartum care starts immediately after delivery and runs for six weeks. Check with the payer for its specific policies on postpartum care, as policies may vary. For example, CIGNA® allows six weeks postpartum care for vaginal deliveries, but extends the period to eight weeks for cesarean deliveries.#N#If the provider is reporting the global maternity package, all postpartum visits are included in the global code. If the provider is not claiming the global maternity package, and is providing postpartum care only, report 59430 Postpartum care only (separate procedure). This code includes all after-delivery E/M visits related to the pregnancy.#N#Example: A patient vaginally delivers a healthy infant. The patient moves to another town immediately following her delivery, and presents to a new OB/GYN provider for postpartum care. Because the new OB/GYN is providing only postpartum care, proper coding is 59430.

What is code 99217-24?

99217-24 Observation care discharge day management (This code is to be utilized by the physician to report all services provided to a patient on discharge from “observation status” if the discharge is on other than the initial date of “observation status.” #N#Remember: The global maternity package includes uncomplicated care. Because this patient was diagnosed with pre-term labor and admitted to observation, this is not uncomplicated care and, thus, it is separately reportable with the observation E/M codes. Modifier 24 is needed to indicate these encounters are unrelated to the global maternity package.#N#Dawson Ballard, Jr., CPC, CEMC, CCS-P, is a coder at Town Plaza OBGYN in Overland Park, Kan., and a member of the Overland Park local chapter.

What is modifier 24?

Modifier 24 is needed to alert the carrier that the E/M service (s) is unrelated to the global OB package (for a detailed explanation, see “Related or Not? Pass the Modifier 24 Paternity Test” on page 24).#N#Example: An established patient at 22-weeks gestation is admitted to hospital observation with pre-term labor. The pa-tient’s OB/GYN visits the patient in observation and performs a comprehensive history, exam, and MDM of moderate complexity. The next day, the OB/GYN returns and determines the patient has improved. The patient is discharged from observation care with orders to follow up in the OB/GYN’s office in one week. Correct coding for these encounters:

What is a 99219-24?

99219-24 Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity.

How many antepartum visits should be billed?

The global obstetric (OB) code should be billed whenever one practitioner or practitioners of the same group provide all components of the patient’s obstetrical care, including; 4 or more antepartum visits, delivery, and postpartum care. The number of antepartum visits may vary from patient to patient, however, if global OB care (more than 3 antepartum visits, delivery, and postpartum care) is provided, ALL pregnancy-related visits (excluding inpatient hospital visits for complications of pregnancy) should be billed under the global OB code. Individual E/M codes should NOT be billed to report pregnancy-related E/M visits.

How long does postpartum care last?

Postpartum care begins after the patient is discharged from the hospital stay for delivery and extends throughout the postpartum period (56 days for vaginal delivery and 90 days for cesarean delivery).

Is C section only reimbursement?

If a C-section is performed, the reimbursement for the delivery only charge includes payment for the surgical procedure as well as the post-surgical care.

Is postpartum part of global delivery?

Services rendered during the global period of another service are often overlooked. ‘Typical’ prenatal and postpartum visits are a part of the global delivery package. Problems not related to pregnancy, such as yeast infections, vaginitis, and sexually transmitted diseases (STDs), are not part of the global delivery package. Problems not related to pregnancy may be billed separately at the time of service or treatment.

Do you have to bill out antepartum care separately?

If your doctor does the delivery, then you're not going to bill out separately for the routine antepartum care. If you are unsure about who is doing the delivery, then you need to "wait and see." The global OB codes (59400, 59510, 59610, 59618) includes the PN care. Carriers will routinely deny any antepartum services billed before delivery because they assume they will be getting a claim for the global.

Do you have to specialize in OB to use antepartum codes?

No, you do not have to specialize in OB to use the antepartum codes. You use those codes for routine prenatal care no matter what. And because your choice of code is dependent on # of visits provided throughout the pregnancy, you have to wait to choose your code until patient's care for this particular pregnancy is over & done in your practice.