Maternity Care
Maternity care is safe and high quality health care treatment given in relation to pregnancy and delivery of a newborn child. For billing maternity care, usually a single code can be reported to bill ?Normal, Uncomplicated? maternity care, based on the delivery:
The Maternity Care codes are as follows:
- 59400Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
- 59510Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
- 59610Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery
- 59618Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery
If the physician does not perform all services described by the global codes i.e:
If the patient receives:
- Irregular or late prenatal care,
- Experiences a miscarriage or terminates a pregnancy, or
- Changes providers during the pregnancy), you may report delivery, antepartum care, and postpartum care independently of one another, using dedicated codes.
There?s a common maternity care coding and billing scenario that CPT(R) guidelines do not address:
There are cases where the patient switches insurance during the pregnancy, but maintains the same physician.
In such a case, proper billing will depend on the payer. As a general rule, each insurer will pay only for that exact portion of care for which it is responsible.
An explanation to the above scenario is illustrated here:
The patient presents to the clinic for obstetrical care in the 8th week of her pregnancy. She is seen monthly, and in her 21st week she has a change of insurer. She continues to be seen monthly for the remainder of her first 28 weeks, then biweekly to 36 weeks, and then weekly until her delivery at 39 weeks for a total of 13 visits. The clinic performs the vaginal delivery and provides the postpartum care.
The billing office bills the first four visits to carrier A with 59425 [Antepartum care only; 4-6 visits] using the date of the first visit as the ?from?date? and the date of their last visit before the change in insurance as the ?to date?. The additional nine visits are billed to carrier B with 59426 [Antepartum care only; 7 or more visits]. This claim also bills the delivery and postpartum care with 59410 [Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care]. The delivery date should be used as the date of service for all services on both claims.
There can be exceptions to this rule also. For example, if the patient delivers late or has multiple ?worried well? visits from the point she switched insurance, the requirements of insurance ?B? might be met, and global billing (e.g., 49400)?not itemized billing?may be warranted.