Uncomplicated pre-natal care usually includes a complete examination followed by monthly visits to 32 weeks, then visits every second week to 36 weeks, and weekly visits thereafter to delivery. In complicated pregnancies, charges for additional visits will be given independent consideration upon explanation.
Where a patient transfers her total on-going uncomplicated pre-natal care to another physician, the second physician also may charge a complete examination (item 14090) and subsequent examinations, as rendered. To facilitate payment the reason for transfer should be stated with the claim. Temporary substitution of one physician for another during days off, annual vacation, etcetera, should not be considered as a patient transfer.
Other than during pre-natal or post-natal visits, it is proper to charge separately for all visits (including counselling) for conditions unrelated to the pregnancy, under appropriate fee items listed elsewhere. The reason for the charges should be clearly spelled out when submitting claim.
iv) Other than procedures, services for the care of unrelated conditions, during a pre-natal or post-natal visit are included in the pre-natal (14091) or post-natal visit fee (P14094), and are not to be billed under fee item 04007. Procedures rendered for unrelated conditions are chargeable as set out in Preamble D. 8. d..
Please reference the billing pre-amble for these relevant interpretations of this billing code:See Pre-Amble Notes