Third-party payment denials have produced a concern among family physicians perplexed over how to code for their services. This concern manifested itself in resolutions submitted to the AAFP's Congress of Delegates. Such denials and resolutions have produced a realization at the AAFP that many family physicians are unaware of the options they have under the current CPT guidelines to effectively code the services they render to their maternity patients.
Therefore, a purpose of this discussion paper is to educate family physicians in appropriate coding. Another purpose is to inform patients and their insurance companies of the many legitimate and critical services provided by family physicians who perform maternity care services. To these ends, this discussion paper will review the various CPT codes that family physicians can use when providing maternity care services, outline the CPT definitions of these codes, and briefly discuss potential interpretations and applications of the codes as they relate to the specific arena of family medicine maternity care.
Of course, different carriers have different interpretations of the CPT codes, which means not everyone will accept the coding strategies recommended. Accordingly, family physicians may need to reconsider the coding suggestions in this paper on a case-by-case or company-by-company basis. Furthermore, carriers that are not used to coding in this manner may respond by reviewing submitted claims. In such situations, accompanying the claim with supporting documentation, such as a copy of the hospital admission note, intrapartum progress notes, or a written summary outlining the nature of the services provided, is important. Given the alternative of improper payment, the extra effort is worthwhile.
The American Academy of Family Physicians would be interested in hearing from any members regarding criticisms, concerns, suggestions or critiques of the coding instructions herein described. In addition, the AAFP would be interested in receiving the names of insurance companies who refuse to pay for these services. Inquiries may be directed to:
Cindy Hughes, CPC
Coding & Compliance Specialist
American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Leawood, KS 66211
1-800-274-2237 Ext. 4176
CPT codes, descriptions, and two digit numeric modifiers only are copyright 2008 American Medical Association. All rights reserved.
Coding for Intrapartum and Other Maternity Care
