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Coding for Intrapartum and Other Maternity Care

For family physicians providing routine maternity care, the issue of coding for services rendered has resulted in questions and confusion. Likewise, many family physicians who provide non-routine maternity care find coding such services equally perplexing, in part because none of the existing CPT codes describe complicated prenatal or intrapartum care. Coding difficulties, in turn, create difficulties in getting third-party payers to recognize or pay for these services.

Overview -- A review of the various CPT codes that family physicians can use when providing maternity care services, and a brief discussion of potential interpretations and applications of the codes as they relate to the specific arena of family medicine maternity care.

Global Routine Maternity Care -- Learn the four codes representing routine, global maternity care.

When Maternity Care Begins -- Initiation of maternity care is generally considered to have taken place if an initial history and assessment of risk is completed, the patient is counseled regarding pregnancy care, an antepartum record is initiated, or an ultrasound examination is performed to date the pregnancy.

When the Family Physician Does Not Provide the Global Service -- For a variety of reasons, some women receive prenatal, delivery and postpartum care from more than one physician.

Sample Letter to Payer Regarding Non-global Care in the OB Period

Using Other Evaluation and Management Services in Maternity Care -- Coding for other services, including hospital services, prolonged physician services, critical care and attendance at delivery and other newborn care.

Other Maternity Care Services -- Other services, including fetal monitoring, dilation and curettage, ultrasound and anesthesia.

Attendance at Delivery and Stabilization -- Services including standby during cesarean or high-risk delivery, attendance at delivery with initial stabilization of the newborn, or newborn resuscitation in the delivery or birthing room.

Coding Scenario -- A scenario that illustrates how the coding strategies discussed in this section are applied.

Conclusion -- Many practices find it useful to have their office staff discuss charges at the beginning of the pregnancy so that patients are well aware in advance of the potential costs of complications, should they occur.