COBGC Evaluation and Management Coding 2 — Questions and Answers
Question 1: Which CPT code represents antepartum-only care when a provider furnishes 7 or more visits but does not perform the delivery or postpartum care?
- 59400
- 59425
- 59426 (Correct answer)
- 59430
Correct answer: 59426
CPT 59426 covers antepartum-only care of 7 or more visits when another provider will handle delivery and postpartum services.
Question 2: Modifier 24 appended to an E&M service code during the global OB period indicates that the service is:
- A reduced or eliminated service
- An unrelated E&M performed during a postoperative global period (Correct answer)
- A significant E&M performed on the same day as a procedure
- A prolonged service beyond the typical time
Correct answer: An unrelated E&M performed during a postoperative global period
Modifier 24 signals that the E&M service is unrelated to the original procedure or delivery and is performed during the postoperative or global period.
Question 3: A patient who delivered vaginally is seen six weeks later for her postpartum check-up only, and the delivering physician is reporting this visit separately. Which CPT code applies?
- 59400
- 59410
- 59425
- 59430 (Correct answer)
Correct answer: 59430
CPT 59430 is reported for postpartum care only when billed separately from the global OB package.
Question 4: A patient who had a cesarean delivery is seen two weeks postoperatively for treatment of a urinary tract infection unrelated to her surgery. The appropriate modifier to append to the E&M code is:
- Modifier 25
- Modifier 57
- Modifier 24 (Correct answer)
- Modifier 59
Correct answer: Modifier 24
Modifier 24 is required to indicate that the E&M service (UTI management) is unrelated to the global surgical/OB period.
Question 5: Under the standard prenatal care schedule, the global OB package (e.g., 59400) typically encompasses approximately how many antepartum visits?
- 8
- 10
- 13 (Correct answer)
- 16
Correct answer: 13
The global OB package includes approximately 13 antepartum visits following the standard schedule of monthly visits early in pregnancy, bi-weekly around 28–36 weeks, and weekly near term.
Question 6: Provider A manages a patient's antepartum care for 5 visits and then transfers care. Provider B completes the remaining antepartum visits, delivers the baby, and provides postpartum care. Which code should Provider A report?
- 59400 with modifier 52
- 59425 (Correct answer)
- 59426
- 59430
Correct answer: 59425
CPT 59425 (antepartum care only, 4–6 visits) is reported by Provider A because they delivered 4–6 antepartum visits and did not perform the delivery or postpartum care.
Question 7: Since Medicare stopped recognizing consultation codes in 2010, how should a maternal-fetal medicine specialist report an inpatient consultation for a high-risk pregnancy with high-complexity MDM?
- 99255
- 99223 (Correct answer)
- 99244
- 99251
Correct answer: 99223
Medicare requires inpatient consultations to be reported using the appropriate initial hospital care code; 99223 corresponds to high-complexity MDM.
COBGC Evaluation and Management Coding 2
Which CPT code represents antepartum-only care when a provider furnishes 7 or more visits but does not perform the delivery or postpartum care?