One of our providers (a midwife) had 13 antepartum visits with a patient, only to have the patient require a cesarean. I know 59426 covers 7 or more visits, but with 13, should we submit the related notes with a paper claim?
The code 59426 is used for any number of antepartum visits equaling 7 or more, so the midwife’s care will indeed fall under this code definition. However, you might be interested to know that the code was valued under the Medicare resource-based relative value scale system on the assumption that the average number of visits would be 10 (1 initial and 9 subsequent antepartum visits). If the midwife documented significant additional work due to developing complications at the end of the pregnancy, adding modifier-22 (unusual services) may be appropriate.