How To Use CPT Code 59426

CPT 59426 is a mini global code for antepartum care only, covering seven or more visits. This article will discuss the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 59426 procedures.

1. What is CPT 59426?

CPT 59426 is a code used to represent antepartum care only, specifically for cases where a provider has given seven or more antepartum visits. This code is applicable when a patient transfers out of the practice before delivery, the pregnancy terminates before delivery, or when the provider does not provide all antepartum care but performs the delivery with or without postpartum care.

2. 59426 CPT code description

The official description of CPT code 59426 is: “Antepartum care only; 7 or more visits.”

3. Procedure

The 59426 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 of the mother, with subsequent examinations at each visit thereafter that include both maternal and fetal markers to identify if the pregnancy is progressing normally

4. Qualifying circumstances

Patients eligible to receive CPT code 59426 services are those who have had seven or more antepartum visits with the provider. This can occur when the patient transfers out of the practice before delivery, the pregnancy terminates before delivery, or when the provider does not provide all antepartum care but performs the delivery with or without postpartum care.

5. When to use CPT code 59426

It is appropriate to bill the 59426 CPT code when a provider has given seven or more antepartum visits, regardless of whether the provider performs the delivery or not. This code is used when the patient transfers out of the practice before delivery, the pregnancy terminates before delivery, or when the provider does not provide all antepartum care but performs the delivery with or without postpartum care.

6. Documentation requirements

To support a claim for CPT 59426, the following information needs to be documented:

  • Number of antepartum visits provided
  • Comprehensive initial history and physical of the mother
  • Subsequent examinations at each visit, including maternal and fetal markers
  • Any additional services provided, such as antenatal screening tests, care for conditions unrelated to pregnancy, injections, surgical procedures, and ultrasound examinations

7. Billing guidelines

When billing for CPT code 59426, it is important to follow these guidelines:

  • Ensure that the provider has given seven or more antepartum visits
  • Document all necessary information to support the claim
  • Consider adding a modifier 22 (Increased procedural services) if the provider sees the patient more than ten times due to complications of the pregnancy and the documentation warrants it
  • Do not use modifier 24 (Unrelated evaluation and management service) during the antepartum period, as this modifier only applies to the postoperative period, which begins after delivery

8. Historical information

CPT 59426 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 59426

Five similar codes to CPT 59426 and how they differentiate are:

  • CPT 59400: Includes routine obstetric care, including antepartum care, vaginal delivery, and postpartum care
  • CPT 59410: Includes routine obstetric care, including antepartum care, vaginal delivery, and postpartum care, but with a shorter postpartum period
  • CPT 59425: Antepartum care only, covering 4-6 visits
  • CPT 59430: Postpartum care only
  • CPT 59510: Includes routine obstetric care, including antepartum care, cesarean delivery, and postpartum care

10. Examples

Here are 10 detailed examples of CPT code 59426 procedures:

  1. A patient transfers to a new practice after receiving eight antepartum visits from the previous provider
  2. A patient has a pregnancy termination after nine antepartum visits
  3. A provider performs the delivery but did not provide all antepartum care, with the patient having received seven antepartum visits from another provider
  4. A patient receives ten antepartum visits due to complications in the pregnancy
  5. A patient receives seven antepartum visits and then moves to a different city, requiring a transfer of care
  6. A patient receives eight antepartum visits before experiencing a miscarriage
  7. A provider performs the delivery but did not provide all antepartum care, with the patient having received nine antepartum visits from another provider
  8. A patient receives seven antepartum visits and then decides to switch providers for personal reasons
  9. A patient receives nine antepartum visits before experiencing a stillbirth
  10. A provider performs the delivery but did not provide all antepartum care, with the patient having received ten antepartum visits from another provider

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