Can’t bill 59400 because you didn’t provide complete antepartum care? You can apply a mini global code, like CPT code 59425. Adequate prenatal care is very important for a healthy, full-term pregnancy. Healthcare providers are now moving from the traditional maternity care, consisting of 12 to 14 in-person visits, towards a more personalized approach.
However, you still have to follow the billing rules. So, how should you bill for a patient who switches practices in the middle of their prenatal care? Let us help you with this problem by explaining the 59425 CPT code.
CPT Code 59425 – Description
CPT code 59425, as we mentioned earlier, is like a mini global prenatal care code. To be specific, it specifies partial maternity care and helps healthcare providers bill 4 to 6 in-office visits during the antepartum phase. This happens when a patient leaves or transfers care services in the middle of their pregnancy. In short, this code does not include delivery and postpartum care.
Scenarios Where CPT Code 59425 is Applicable
As you may have noticed, CPT code 59425 depends heavily on how much care you provided to the patient. To understand its application, here are three specific scenarios discussing the circumstances that led to the transfer or discontinuation of care.
Switching Care to Another Provider due to Relocation
Many women understand the importance of early prenatal care. That’s why 76.1% of live births happened to those who received timely care in 2023. So, for this scenario, let’s suppose a 25-year-old woman starts her maternity care at the 5th week of gestation. She visits her OBGYN (let’s assume her name is Jenna) every month.
However, after the fifth visit, she has to relocate to another state due to her husband’s job. Hence, she also transfers care to another provider closer to her home. Dr. Jenna, on the other hand, bills those 5 in-office visits with CPT code 59425.
Billing for Late Prenatal Visits
What if you are the healthcare provider the patient is transferring care to? Let’s look at another example from this angle. Let’s suppose the patient switches to your practice at the 28th week of gestation. Let’s assume you saw the patient 6 times before her delivery. In this case, you can bill those 6 prenatal care visits with CPT code 59425, and delivery and postpartum care with another code (59410).
Partial Prenatal Care due to Pregnancy Termination
While most abortions happen in the first trimester, it is possible to terminate a pregnancy until 24 weeks. Let’s use this information in our final scenario! Consider a 29-year-old first-time pregnant woman.
She starts her prenatal care at the 7th week of gestation. She sees her OBGYN once a month. However, at the 24th week, she is diagnosed with cancer and hence opts to terminate her pregnancy. Since the physician provided care over 4 visits, she uses CPT code 59425 to bill for partial prenatal care.
CPT Code 59425 – Billing & Reimbursement Guidelines
You can follow our billing and reimbursement guidelines for CPT code 59425 to receive fair reimbursements for partial antepartum care.
Use CPT Code 59425 to Bill for 4 to 6 Visits
While this code is for partial prenatal care, it specifically covers 4 to 6 visits. Hence, avoid using it for fewer than 4 or more than 6 in-office visits. You can use standard E/M codes for the former, and a different mini global code, CPT 59426, for the latter.
Do Not Use this Code for Delivery or Postpartum Care
Remember that CPT code 59425 does not include delivery or postpartum care. Hence, if you also helped deliver the baby in addition to providing partial maternity care, you must bill for that delivery and postpartum care separately. We have already discussed this in the scenarios section.
Document Each Prenatal Visit
You should document every antepartum visit thoroughly to avoid any confusion. This includes keeping a record of the following details:
- Total visit count
- Date of each visit
- Services provided during each session, including assessments or counseling
- Reason for partial care (miscarriage, abortion, transfer to another provider, or more)
Verify Coverage Rules
Finally, coverage rules and reimbursement rates for CPT code 59425 may vary from payer to payer. Hence, check their maternity care guidelines before filing a claim for this code.
Summary
Instead of using a complete obstetric care code, use a mini global code to bill for partial prenatal care. CPT code 59425 is one such code. To summarize, it helps you report 4 to 6 in-office antepartum visits without delivery. So, if your patient transferred to another location in the middle of maternity care or decided to terminate their pregnancy, you can use this code to receive compensation for your efforts.
We have provided a simple description of the 59425 CPT code along with all possible scenarios to help you use it correctly. However, if you are still unable to bill partial maternity cases, you can choose a professional biller to help you document everything. Our OBGYN billing services guarantee smooth and fair reimbursements.
