Taking the Pain Out of Handling Pregnant Patient Transfers

Medical billing for pregnant patients is a fairly cut and dried process. It’s easy to create medical necessity for the visits and it’s easy to show the reasons for the continued visits. That is, unless the patient transfers practices in the middle of her prenatal care. Pregnancy transfers scare many medical billing personnel, however you can use three easy tips and make your maternity patient transfers a breeze.

How you do medical billing for a maternity transfer all depends on how many times she was seen in the clinic. If she was seen 1-3 times you always want to code those visits as evaluation and management visits. One thing to keep in mind is that the first antepartum visit is not as straight forward as you may think. Always keep track of the level of service (level 4 or level 5) before doing medical billing for this date.

The next tip deals with visits 4-6. This means that the maternity patient was fairly established with your practice before transferring. It is quite simple to do medical billing for these visits. Simply use CPT code 59425. This code covers every antepartum care visit in your office. It is by far, the simplest way to do maternity transfer medical billing.

Last, if the pregnant patient is seen in your office seven or more times, there is a code that encompasses all of those visits as well. The CPT code is 59426. You should never bill for a global fee because a global fee in medical billing means that your physician also delivered the baby. This is coded with 59400-59622.

Some payers can also get confused when the initial transfer is made. In some cases they will ask for you to report separately. Most of the time, they still want you to code 59425 or 59426, but want all the dates listed in chronological order by date of service.

View all Articles by: Melissa Clark, CCS-P