Between 2013 CPT code changes and Medicare screening services, OB/GYN practices have key items to keep up with. These include:
2013 CPT Codes for OB/GYNs
The Current Procedural Terminology, Fourth Edition, (CPT-4) code set for 2013 includes a few updates of interest to OB/GYNs. Extensive new instructions and guidelines have been added to the CPT manual to help clarify coding in a variety of situations.
Medicare Screening Services 2013
Physicians are often confused about how to document and report preventive services provided to their Medicare patients. This is particularly true with the ongoing implementation of the Affordable Care Act (ACA). This document provided by ACOG is designed to assist physicians in documenting, reporting and receiving reimbursement for these preventive services, and provides tables outlining HCPCS, CPT and ICD-9 Codes.
Read the full guide, with tables, at
How to Correctly Split Antepartum Care Reimbursement
When your obstetrician shares maternity care with a physician outside a group practice, you will have to abandon the global codes (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care; 59510, Routine obstetric care including antepartum care, cesarean delivery, and postpartum care; 59610, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care, after previous cesarean delivery; and 59618, Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery).
When patients change providers during the course of their pregnancies, the OB coders wonder: What options do we have in accurately coding and reporting the services provided?
Tip 1: 3 Choices for Coding Antepartum Care
If your OB/GYN only provides antepartum care, you have three potential ways to report his services.
Option 1: If the patient had a total of one to three antepartum visits, report the appropriate level of E/M service for each visit with the date of service that the visit occurred and the diagnosis for why the patient was seen,?óÔé¼?Ø states the American Congress of Obstetricians and Gynecologists (ACOG). For example, if the doctor sees an OB patient twice before she moves to a different area, you would report the appropriate E/M code (99201-99215) for each visit with V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy).
Option 2: On the other hand, if the OB/GYN sees the patient four to six times before she leaves his care, you will report 59425 (Antepartum care only; 4-6 visits), ACOG states. Because 59425 represents the total work involved with all of the visits, you should submit it only once with a “1”?Ø in the units box of the CMS-1500 claim form. Also, be sure to include the “to”?Ø and “from”?Ø dates during which the services occurred.
Enter the first prenatal visit in box 15 and only enter the last visit the patient was seen for prenatal care in box 25a. Many coders were receiving rejections due to file limit if they entered a duration of dates. The claim software was looking at the first date in box 25a and not the “from”?Ø date.
Option 3: If your physician provides seven or more antepartum visits, you should report 59426 (… 7 or more visits), according to ACOG. As with 59425, you should report 59426 only once and place a “1” in the units box. You should also record the “to” and “from” dates for the services your OB/GYN provided.
To avoid reimbursement hassles, be sure to ask your carriers how they want multiple antepartum visits coded. Some payers may allow you to bill an E/M service instead of the antepartum visit package codes. And reporting individual visits allows you to get paid at the time of service rather than waiting until you complete the required number of visits and billing the corresponding code.
Tip 2: Patient Transfer May Mean Reporting the Global
When a patient transfers to your OB/GYN practice late in her pregnancy, your first task is to determine if she has received any antepartum care elsewhere, ACOG recommends. If she has received antepartum care from another physician, you will not be able to report the global OB code (59400, 59510, 59610 or 59618). Instead, you will have to report the antepartum care (59425-59426), delivery (59409-59410, 59514-59515, 59612-59614) and possibly postpartum care (59430) separately. If the OB/GYN performs the delivery and postpartum care, CPT?« includes 59430 with the code for delivery with postpartum care.
The physician who provided the initial antepartum care will bill separately for his services. Consequently, if you bill the global in this case, you would be reporting some antepartum care that you did not perform.