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The CPT® Code 59425 refers to the provision of antepartum care only, specifically encompassing a total of four to six visits. Antepartum care is the medical care provided to a pregnant woman before the onset of labor. This care is crucial for monitoring the health of both the mother and the developing fetus throughout the pregnancy. The physician's role in this context includes conducting an initial maternal history assessment and evaluating the overall health status of both the mother and fetus. During the initial visit and any subsequent visits, the physician will perform several routine checks, including weighing the mother, measuring blood pressure, monitoring fetal heart tones, and conducting a routine chemical urinalysis. It is important to note that this code is applicable in situations where antepartum care is provided exclusively, which may occur due to circumstances such as the termination of the pregnancy by miscarriage or abortion, or if the patient is transferred to another physician for continued care. For cases where the patient requires seven or more visits for routine antepartum care, the appropriate code to use would be CPT® Code 59426.
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The indications for using CPT® Code 59425 include the following scenarios where antepartum care is necessary:
The procedure for CPT® Code 59425 involves several key steps that ensure comprehensive antepartum care is delivered effectively:
Post-procedure care following the antepartum visits coded under CPT® Code 59425 typically involves continued monitoring of the mother's health and the fetus's development. The physician may provide guidance on lifestyle modifications, nutritional advice, and any necessary follow-up appointments. If complications arise or if the pregnancy progresses to a point where labor is imminent, the physician may refer the patient to an obstetrician for further management. It is essential for the patient to maintain regular follow-up visits to ensure both maternal and fetal health are adequately monitored throughout the antepartum period.
| Short Descr | ANTEPARTUM CARE ONLY | Medium Descr | ANTEPARTUM CARE ONLY 4-6 VISITS | Long Descr | Antepartum care only; 4-6 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) |
| U2 | Medicaid level of care 2, as defined by each state | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | 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 | SB | Nurse midwife | U1 | Medicaid level of care 1, as defined by each state | U9 | Medicaid level of care 9, as defined by each state |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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