Prenatal Visits

Uncomplicated prenatal care usually includes a complete examination followed by monthly visits. Visits for prenatal care are billed under the following fee items:

Fee Item Frequency

14090

Prenatal visit - complete examination

1 per patient per pregnancy
14091 Prenatal visit - subsequent examination 14 per patient per pregnancy

Prenatal visit - complete examination (fee item 14090)

Fee item 14090 is normally billed only once during a patient's pregnancy.

When a patient transfers her prenatal 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 14090 (complete examination) includes fee item 14560 (Routine pelvic examination including Papanicolaou [Pap] smear).

Prenatal visit - subsequent examination (fee item 14091)

For routine, uncomplicated prenatal 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 prenatal visits as are medically required. Examples of such conditions are:

  • diabetes
  • post-maturity
  • hypertension
  • toxemia
  • pre-eclampsia
  • previous intrauterine death
  • pre-mature labour
  • HELLP Syndrome

Visits unrelated to prenatal 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 prenatal and postnatal period

There is no charge for fee item 14560 when done during the pre and postnatal service, except if a Pap smear is specifically requested by the BC Cancer Agency (BCCA) and then it may be billed during the pre and postnatal period. If the specially requested Pap smear (fee item 14560) is done at the same time as a prenatal visit, the lesser fee should be billed at 50%, in accordance with Preamble Minor Diagnostic and Therapeutic Procedures. 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 prenatal visit, refer to the MSC Payment Schedule Preamble-'Minor Diagnostic and Therapeutic Procedures'.

 

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Disclaimer: MSP Tutor is intended to provide a guide for physicians and medical office assistants in billing claims to MSP. For definitive information on fee-for-service fee item codes and amounts, consult the current MSC Payment Schedule. If a discrepancy exists between the information contained in MSP Tutor and the MSC Payment Schedule, the information in the Payment Schedule will prevail.