• 1.  Tracking Codes w/ E/M

    Posted 02-22-2021 13:45
    Good afternoon,

    I have a question about billing tracking codes 0502F with E/M on the same encounter. If you have a patient that is severely high-risk with a lot of mobility conditions in her pregnancy and this patient is seen more often than normal due to these issues are you allowed to bill 0502F with 99214 if the MDM warrants this level 4. Or should the removed 0502F and only bill for the E/M? Most of the MFM patients are seen for high-risk issues but we were wondering if a patient's condition is not considered routine prenatal care because of the pre-existing chronic issues are you able to bill for a regular E/M instead due to the nature of the high-risk complications the patient continues to have.

    I apologize if this is confusing. I appreciate any help with this.

    Norah AL-Hussaini

    Norah Al-Hussaini

  • 2.  RE: Tracking Codes w/ E/M

    Posted 02-23-2021 08:57
    Hi Norah
    I am not familiar with the 0502F codes. Can I ask that you submit this question to the Coding Q&A so that the coders on the committee can weigh in?

    Vanita Jain, MD
    Chair, SMFM Coding Committee

  • 3.  RE: Tracking Codes w/ E/M

    Posted 02-23-2021 11:05
    Hi Norah,
    Codes 0500F, 0501F, 0502F & 0503F are used to identify first prenatal visit, first prenatal flowsheet, stand-alone visit, and postpartum visit respectively. They are category II codes which are helpful for quality reporting, such as to indicate enrollment in prenatal care in the first trimester, etc. Please keep in mind that a "high-risk visit" for a generalist obstetrician may be an average visit for a MFM specialist, so it would not be reasonable that all your visit are high complexity. If you are following the pregnancy, you need to decide if you want to bill global or not, though your payer may restrict non-global billing in the contract. Category II codes may be used whether global billing is used or the visits billed individually.

    Fadi Bsat, MD
    Past Chair, SMFM Coding Committee

  • 4.  RE: Tracking Codes w/ E/M

    Posted 02-23-2021 11:37
    Thanks Fadi
    Yes, was just talking to Trish - these are typically required by payers for practices performing routine prenatal care
    I apologize that this is not an area I am familiar with being consultative only in our private office
    Trish mentioned currently she is not aware of payers requiring MFM groups to utilize these codes.
    Norah, your question is also in the queue for formal Committee response as well

    Vanita Jain, MD
    Chair, SMFM Coding Committee