Coding Guide for Maternity Care and Delivery subsection (59000-59899)

The Maternity Care and Delivery subsection (cpt code 59000–59899) is divided according to type of procedure. As a general rule, the subsection progresses from antepartum procedures through delivery procedures. The guidelines are very detailed as to the services included in antepartum and delivery care, not only to facilitate coding, but also to help guard against unbundling. We have various topic earlier about coding normal and complication pregnancy codes, but this one has separate guideline and procedure codes.

Pregnancy confirmation during a problem oriented or preventive visit is not considered part of antepartum care and should be reported using the appropriate Evaluation and Management code for that specific visit. 

Coding Guide for Maternity Care and Delivery subsection (59000-59899)
Abortion codes (spontaneous abortion, missed abortion or induction of abortion) indicate the treatment of a spontaneous or missed abortion, including additional division on the basis of trimester and induction of abortion by method. The coder must be aware of gestational age of the fetus to determine the correct code.

Treatment of ectopic pregnancies is based on the site of the pregnancy, the extent of the surgery and whether the approach was by means of laparoscopy or laparotomy (incision through abdominal wall).

The gestation of a fetus takes approximately 266 days, but when the estimated date of delivery (EDD) is calculated, 280 days often is used in the calculation, counting the time from the last menstrual period (LMP). The gestation is divided into three time periods, called trimesters. The trimesters are as follows:

Trimester 

First : LMP to less than 14 weeks 0 days
Second :14 weeks 0 days to less than 28 weeks 0 days
Third: 28 weeks 0 days until delivery

Do remember now, the weeks of gestation codes of Z3A category has revised guideline in 2018. This category should be used only with 009-09A codes. 

Read also: Best guide for coding Biophysical Profile in Radiology

CPT codes for Global OB Care fall into one of three categories:

Single-component codes (for example, delivery only)
Two-component codes (for example, delivery including postpartum care)
Three-component, or complete, global codes (including antepartum care, delivery, and postpartum care)  The codes are as follows: 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, and 59622.

Read also: How to improve your skills in coding ICD 10 and CPT codes

CPT codes for Routine obstetrical care

There are four codes that describe the global routine obstetrical care that includes antepartum care, delivery, and postpartum care, based on the type of delivery:
Code Description

59400      Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care

59510       Routine obstetric care including antepartum care, cesarean delivery, and postpartum care

               

59514       Cesarean delivery only;

59610    Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery

59618  Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery

Curettage at the time of delivery is included in the delivery code (59400 – 59410). However, postpartum curettage may performed for a surgical complication after delivery (e.g., retained products of conception). In this instance, code 59160 would be reported with the modifier 78 appended to represent a return to the operating room for a related procedure during the postoperative period.

During delivery, if a vaginal laceration or tear occurs and the repair is minimal, the repair of the laceration is an inclusive component of the delivery services and is not coded separately.

Delivery codes (eg, 59409) are only reported after 20 weeks and zero days of gestation

No additional code should be reported for induction of labor as it is an inclusive component of the complete obstetrical package

Common Abbreviations Description

VBAC : Vaginal birth after cesarean
VBACS : Vaginal birth after cesarean section

Read also: Procedure codes used for coding Twins in Radiology

Coding guide for Obstetrical Care for  Twins

If the global obstetrical care is provided and twins are delivered, the same codes are reported, but—depending on the third-party payer—modifier -22 (increased procedural services) or -51 (multiple procedures) is added. Usually, if both twins are delivered vaginally, 59400 is reported for twin A and 59409-51 for twin B. If one is delivered vaginally and one is delivered by C-section, 59410 is reported for twin B and 59409-51 for twin A. If both are delivered via C-section, only 59510 is reported, because only one C-section was performed.

Delivery Method                                        Code for Twin A            Code for Twin B

Both twins delivered vaginal                           59400                          59409-51
Other twin delivered cesarean                        59409-51                        59510
Both twins delivered cesarean                                             59510

59400 – Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care

59409 – Vaginal delivery only (with or without episiotomy and/or forceps)

59510 – Routine obstetric care including antepartum care, cesarean delivery and postpartum care

59514 – Cesarean delivery only

59612 – Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps)

Some payers, such as Medicaid in some regions, require 59409 (vaginal delivery) or 59410 (cesarean delivery) to be reported, because they do not recognize the global obstetrical care codes. Each prenatal visit and the delivery is billed separately. This is just another reminder that knowledge of the payers’ rules will ensure prompt and proper payments.

3 Thoughts to “Coding Guide for Maternity Care and Delivery subsection (59000-59899)”

  1. […] Read also: Coding tips for Maternity Care and Delivery Procedure codes […]

  2. […] For example, United Healthcare considers CPT codes 81000 and 81002 as included in the global antepartum or global obstetrical(OB) service when submitted with an OB diagnosis code in an office setting. […]

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