How To Use CPT Code 59425

CPT 59425 refers to antepartum care only for 4-6 visits, and this article will discuss its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 59425?

CPT 59425 is a medical billing code used to represent antepartum care services provided by healthcare professionals for pregnant patients during 4-6 visits. This code is specifically used when a provider offers a limited number of antepartum visits, such as when a patient transfers out of the practice before delivery or when the pregnancy terminates before delivery.

2. 59425 CPT code description

The official description of CPT code 59425 is: “Antepartum care only; 4-6 visits.”

3. Procedure

The 59425 CPT code procedure involves the following steps:

1. Evaluation of the health status of both mother and fetus
2. Estimation of the gestational age
3. Identification of the patient at risk for complications
4. Anticipation of problems before they occur and prevention of problems if possible
5. Education and communication with regard to all issues that relate to the pregnancy, such as the pregnancy plan, counseling for antenatal testing, lactation, and nutritional counseling
6. Comprehensive initial history and physical examination of the mother, with subsequent examinations at each visit thereafter
7. Monitoring of maternal and fetal markers to identify if the pregnancy is progressing normally
8. Additional services, such as antenatal screening tests, care for conditions unrelated to pregnancy, injections, surgical procedures, and ultrasound examinations, may be reported separately based on payer policy

4. Qualifying circumstances

Patients eligible to receive CPT code 59425 services are those who require antepartum care for 4-6 visits. This may occur when a patient transfers out of the practice before delivery, when the pregnancy terminates before delivery, or when the provider does not provide all of the antepartum care but performs the delivery with or without postpartum care because the patient transfers in from another practice and the payer does not allow the provider to bill a global services code such as 59400.

5. When to use CPT code 59425

It is appropriate to bill the 59425 CPT code when a healthcare provider offers antepartum care services for 4-6 visits. This code should be used when the provider does not provide all of the antepartum care but performs the delivery with or without postpartum care, or when the patient transfers out of the practice before delivery or the pregnancy terminates before delivery.

6. Documentation requirements

To support a claim for CPT 59425, the following information needs to be documented:

• Comprehensive initial history and physical examination of the mother
• Subsequent examinations at each visit, including maternal and fetal markers to identify if the pregnancy is progressing normally
• Services provided during each visit, such as evaluation of the health status of both mother and fetus, estimation of the gestational age, identification of the patient at risk for complications, and education and communication regarding pregnancy-related issues
• Number of antepartum visits provided (4-6)
• Reason for the limited number of antepartum visits, such as patient transfer or pregnancy termination

7. Billing guidelines

When billing for CPT code 59425, it is essential to follow payer-specific guidelines and rules. Some tips for billing this code include:

• Ensure that the documentation supports the claim for 4-6 antepartum visits
• Report additional services, such as antenatal screening tests, care for conditions unrelated to pregnancy, injections, surgical procedures, and ultrasound examinations, separately based on payer policy
• Be aware of any payer-specific requirements for billing CPT 59425

8. Historical information

CPT 59425 was added to the Current Procedural Terminology system on January 1, 1994. There have been no updates to the code since its addition.

9. Similar codes to CPT 59425

Five similar codes to CPT 59425 and how they differentiate from CPT 59425 are:

• CPT 59400: Includes routine antepartum care, vaginal delivery, and postpartum care
• CPT 59409: Covers vaginal delivery only, without antepartum or postpartum care
• CPT 59410: Includes vaginal delivery and postpartum care, but not antepartum care
• CPT 59426: Represents antepartum care only for 7 or more visits
• CPT 59430: Covers postpartum care only, without antepartum care or delivery

10. Examples

Here are 10 detailed examples of CPT code 59425 procedures:

1. A patient transfers to a new practice at 28 weeks gestation and receives four antepartum visits before delivering at the new practice.
2. A patient experiences a pregnancy termination after receiving five antepartum visits.
3. A patient receives six antepartum visits before transferring out of the practice prior to delivery.
4. A patient with a high-risk pregnancy receives four antepartum visits before being referred to a specialist for further care.
5. A patient receives five antepartum visits before moving to a different city and continuing care with a new provider.
6. A patient receives four antepartum visits before experiencing a spontaneous preterm delivery.
7. A patient receives six antepartum visits before being admitted to the hospital for preterm labor and delivery.
8. A patient receives five antepartum visits before experiencing a stillbirth.
9. A patient receives four antepartum visits before deciding to switch to a different provider for personal reasons.
10. A patient receives six antepartum visits before being referred to a high-risk pregnancy specialist for the remainder of her pregnancy.