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The CPT® Code 59426 refers to the provision of antepartum care only, specifically for patients who have had seven or more visits. Antepartum care encompasses the medical supervision and support provided to a pregnant woman throughout her pregnancy, prior to the onset of labor. This care is crucial for monitoring the health and development of both the mother and the fetus. In cases where the pregnancy is terminated due to miscarriage or abortion, or if the patient is transferred to another physician's care, the physician may provide antepartum care exclusively. During the initial visit, a comprehensive maternal history is taken, and an evaluation of the health status of both the mother and fetus is conducted. Subsequent visits typically include routine assessments such as weighing the mother, measuring blood pressure, checking fetal heart tones, and performing a chemical urinalysis to monitor the mother's health and the progress of the pregnancy. It is important to note that this code is specifically for situations where the patient has had seven or more visits, distinguishing it from code 59425, which is used for four to six visits of routine antepartum care.
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The indications for using CPT® Code 59426 include the following:
The procedure for CPT® Code 59426 involves several key steps that ensure comprehensive antepartum care is provided to the patient. Each visit is structured to monitor the health of both the mother and the fetus effectively.
Post-procedure care for patients receiving antepartum care under CPT® Code 59426 involves continued monitoring and support as the pregnancy progresses. The physician will schedule regular follow-up visits to ensure that both the mother and fetus remain healthy. Any concerns or complications identified during the antepartum visits will be addressed promptly. If the pregnancy progresses normally, the physician will prepare the patient for labor and delivery, ensuring that all necessary information and care plans are communicated effectively. In cases where the pregnancy is terminated or transferred, appropriate referrals and follow-up care will be arranged to support the patient's ongoing health needs.
| Short Descr | ANTEPARTUM CARE ONLY | Medium Descr | ANTEPARTUM CARE ONLY 7/> VISITS | Long Descr | Antepartum care only; 7 or more visits | Status Code | Active Code | Global Days | MMM - Maternity Code | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | 1 | CCS Clinical Classification | 227 - Other diagnostic procedures (interview, evaluation, consultation) |
| U3 | Medicaid level of care 3, as defined by each state | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GL | Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | TH | Obstetrical treatment/services, prenatal or postpartum | U2 | Medicaid level of care 2, as defined by each state |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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