Code 59425 is used for four to six prenatal visits, and code 59426 i used for seven

or more
prenatal visits.

Example: CPT code 59425 is for antepartum care only, four to six visits. This may
be used by a family practice physician who refer a patient in the second
trimester of pregnancy to an ob tetrician due to a high ri k of complica
tions.

Medical and/or Surgical Complications during Pregnancy

For medical complications of pregnancy such as cardiac problems, neurological

problems,
diabete , hypertension, toxemia, hyperemesis, preterm labor, or premature rupture
of the mem
brane , the coder should refer to services in the medicine and the ElM services
sections of the
CPT code book. For example, when a pregnancy is complicated by gestational diabetes
requir
ing additional office visits for blood sugar monitoring and weight and nutritional
counseling,
the office vi its may be coded using the E/M office visit codes. The diagnosis
should upport
the complication. In this case, gestational diabetes should be linked to the
additional office
visits and/or laboratory work performed.

For surgical complications occurring during pregnancy (for example, appendectomy,

her
nia, ovarian cyst, or Bartholin cy t), the e procedures should be coded from the
appropriate
subsection of the surgery ection.

Vaginal Birth after Cesarean Delivery

Codes for planned attempted vaginal birth after a previous cesarean delivery,
referred to as a
VBAC, are assigned based on whether the vaginal birth was successful or whether a
repeat
cesarean delivery was performed. VBACs are a signed using the code range 59610-
59622.
Elective repeat cesarean deliveries are coded in the cesarean delivery section.

Multiple Gestation

To report services for twins or other multiple birth, the same guidelines apply and
the code
is based on type of delivery when the physician performed the antepartum, delivery,
and post
partum services. It is challenging to code one twin as a vaginal delivery and the
other as a
cesarean delivery. In this case, code 59510 is used for routine obstetric care,
including postpar
tum care, for the cesarean delivery and code 59409 is used for the vaginal
delivery. Code 59400
should not be used for the vaginal delivery because the patient had only one
antepartum and
postpartum period. The package concept for cesarean delivery is coded because the
postpartum
period may be greater due to this type of delivery.

When multiple gestations are delivered by the same method and all were born
vaginally,
the package code would be billed once and then additional, delivery-only codes
would be
added for the subsequent births. CPT Assistant (August 2002) states that an
alternate method
of coding multiple gestation vaginal deliveries is to append modifier -22 to the
59400 code. It
also states that if both twins of a twin birth are delivered via cesarean delivery,
the code 59510
is only reported once.

Multifetal pregnancy reduction (MPR) (59866) is reported for patients with

fertility treat
ments that result in multiple fetal development.