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Case Study
Mrs. Jones presents to the Dr. America's office for prenatal care. Her pregnancy was diagnosed by the local health department and prenatal lab work was done at that time. Dr. America sees Mrs. Jones for 4 prenatal visits. The baby was subsequently delivered by another physician in another practice. The correct method for billing the four prenatal visits would be:

Answer: c

If the patient was seen for a total of 4-6 visits after the initial visit when the pregnancy was diagnosed, then CPT code 59425 (Antepartum care only; 4-6 visits) should be used. If there were at least 7 visits made, then CPT code 59426 would be used. Billing for antepartum care only, when the delivery is performed by another physician in a different practice, should be done according to the number of visits actually spent seeing the patient. If the physician saw the patient initially and established the diagnosis of pregnancy, that visit may be billed separately using an E&M code. If the patient was then seen for an additional 1 to 3 visits, they should also be coded using the E&M codes with the level selection based on the documentation in the medical record. However, if the patient was seen for a total of 4 prenatal visits after the initial visit when the pregnancy was diagnosed, code 59425 should be used. Code 59425 states it is to be used for 4 to 6 visits. The allowance for code 59425 has been established to cover a minimum of 4 visits to a maximum of 6 visits.

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