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Obstetrics coding and claims

Obstetrics coding and claims submission (printable document)

 

 Definitions

 Antepartum Care:

 Before birth

 Delivery:

 Birth process;  vaginal birth, Caesarean section or begin as vaginal and convert to Caesarean

 Postpartum Care:

 After delivery

 Guidelines

 Antepartum care

Definition

Global codes

Type of delivery

First newborn

Subsequent newborn(s)

  • Initial OB visit and subsequent visits
  • Monthly visits to 28 weeks gestation
  • Biweekly visits to 36 weeks gestation
  • Weekly visits until delivery

Services included in the Global OB CPT®’ Code 59400(Vaginal

delivery)or 59510(Cesarean delivery)

N/A

N/A

N/A

 Delivery

Definition

Global codes

Type of delivery

First newborn

Subsequent newborn(s)

  • Admission to hospital
  • Admission history and physical examination
  • Management of uncomplicated labor
  • Vaginal delivery (with or without episiotomy, with or without forceps), or
  • Cesarean delivery

 

NA

Vaginal

Codes: 59400, 59409, 59410,

59610, 59612, or 59614

 

 Use the appropriate vaginal delivery code (usually 59400 or 59610) for the first newborn.

 

The primary procedure will be allowed at 100% of the contracted rate

 Codes:59409 or 59612 Use the appropriate vaginal delivery-only code for each subsequent newborn.(Append with modifier -59)

 

 The secondary procedure will be allowed at 50% of the contracted rate for each newborn.

 

 If there are more deliveries use this code for each live birth (e.g.tripletts, etc.)

Caesarean

Codes:59510, 59514, 59515,

59618, 59620, or 59622

 

Use the appropriate Cesarean delivery code (usually 59510 or 59618) for the first delivery.

 

 

 Codes:59510, 59514, 59515, 59618, 59620, or 59622

 

 Use the appropriate Cesarean delivery code (usually 59510 or 59618) for the first delivery.

 

 

Vaginal delivery(ies) followed by Cesarean delivery(ies)

Codes:59409 or 59612

 

Use the appropriate vaginal delivery-only code for each newborn delivered.

 

 

 Codes:59510, 59514, 59515,59618, 59620, or 59622

 

 If one or more newborns are delivered vaginally and subsequent newborn(s) are

 Delivered by Cesarean, use the appropriate Cesarean delivery code (usually 59510 or 59618) for the Cesarean delivery and the appropriate Cesarean delivery-only code (59514 or 59620) for each subsequent newborn.(Append with modifier -59)

 Postpartum care

Definition

Global codes

Type of delivery

First newborn

Subsequent newborn(s)

  • Hospital visits
  • Office visits following Vaginal or Cesarean delivery

N/A

N/A

N/A

N/A