Billing for Prenatal Visits

Summary:

• Bill the FIRST prenatal visit as a regular level III, IV or V visit (for new or established patient)
• Bill subsequent prenatal visits as "PREN"
• Bill postpartum visits as a regular level III, IV or V visit

Details:

Most of our prenatal patient costs are reimbursed in a single batch payment that includes all prenatal visits (after the first one), plus the delivery.  BUT - we still must track charges for all the prenatal visits.  In the event the patient does NOT deliver with GLFHC, and we do not collect the batch payment, we can collect for the individual prenatal visits after the fact.  This happens when a patient starts prenatal care with GLFHC and subsequently miscarries, has a termination, moves out of the area or chooses an outside OB provider.

Please bill for prenatal visits as follows: 

First prenatal visit
The first visit is where you open the OB Episode and order first-trimester prenatal labs and referrals.  Bill this visit as a regular level III, IV or V visit (depending on time and complexity).  For instance, for a level III, you would bill:

• Established patient: 99213 OFFICE VISIT, EST PT, LOW CMPLX - LEVEL III (L3E)
• New patient: 99213 OFFICE VISIT, NEW PT, LOW CMPLX - LEVEL III (L3N)  

Subsequent prenatal visits
Bill these using the special billing code "PREN".  Note the following:

• When you type "PREN" in the field for the E&M Procedure code, you will NOT see a dropdown to choose from!
• Just type "PREN", then tab or click out of the E&M Procedure code field
• The name of the order, "PRENATAL (SUBSEQUNT VISIT) LEVEL III" will then appear to the right:

Postpartum visit
Bill the postpartum visit as a regular level III, IV or V (just like the first prenatal visit).