Uncomplicated pre-natal care usually includes a complete examination followed by monthly visits.Visits for pre-natal care are billed under the following fee items:
Pre-natal visit - complete examination
|1 per patient per pregnancy|
|14091||Pre-natal visit - subsequent examination||14 per patient per pregnancy|
Pre-natal visit - complete examination (fee item 14090)
Fee item 14090 is normally billed only once during a patient's pregnancy.
When a patient transfers her pre-natal care to another physician, the new physician can also bill fee item 14090, but a note record is required that indicates transfer of care. Temporary substitution by other physicians for vacation or other leave of absence should not be considered a patient transfer.
Fee item 14560 (Routine pelvic examination including Papanicolaou [Pap] smear) is considered included in fee item 14090 when done as a pre- and post-natal service and cannot be billed in addition to fee item 14090.
Pre-natal visit - subsequent examination (fee item 14091)
For routine, uncomplicated pre-natal care, the maximum number of subsequent visits (fee item 14091) that can be billed is usually 14 per patient, per pregnancy.
Some patients will experience complications during pregnancy that will require additional visits; these visits are also billed under fee item 14091. When billing over the limit for complicated pregnancy, the complicating condition must be indicated in the note record and/or diagnostic code field and the physician may bill as many pre-natal visits as are medically required. Examples of such conditions are:
- previous intrauterine death
- pre-mature labour
- HELLP Syndrome
Visits unrelated to pre-natal care:
When a patient is seen for a condition unrelated to her pregnancy, bill under the appropriate visit fee (for example, 00100). These visits are not included in the limit of 14091 X 14 visits per pregnancy. Again, the diagnostic code must reflect the condition the patient was seen for (not related to pregnancy).
Pap test during the pre-natal period:
If a Pap smear is specifically requested by the BC Cancer Agency (BCCA), fee item 14560 may be billed during the pre-natal period. If the specially requested Pap smear (fee item 14560) is done at the same time as a pre-natal visit, the Pap smear should be billed at 50%, in accordance with Preamble B.12.d. A note record is required, indicating that the test was requested by the BCCA.
|TIP:||For billing information regarding other minor procedures performed during the course of a pre-natal visit, refer to Preamble B.12 of the MSC Payment Schedule.|