Other Maternity Care Services
Fetal Monitoring
- 59020* Fetal contraction stress test
Many times, physicians will utilize electronic fetal monitoring to perform a fetal contraction test at the onset of induction or augmentation of labor. If the physician documents this service and provides it in the office or the hospital, with or without the provision of other evaluation and management codes, then the physician should use this code to describe that service in addition to any other services provided. It does not matter what technique the physician uses to induce the contractions (e.g., breast stimulation, oxytocin, etc.).
- 59025 Fetal non-stress test
Again, electronic fetal monitoring provides the option for family physicians to perform fetal non-stress tests before the onset of three or more contractions in a ten minute period. If the physician does this service in the office or the hospital and documents it, then the physician should use this code to describe this service in addition to any other services provided. If the test performed includes evaluation of fetal diaphragmatic breathing movements, fetal body movements, fetal tone and quantification of amniotic fluid volume, code 76818, Fetal Biophysical Profile with non-stress testing should be billed instead.
- 59050 Fetal monitoring during labor by consulting physician (i.e., non-attending physician) with written report; supervision and interpretation
- 59051 Fetal monitoring during labor by consulting physician (i.e., non-attending physician) with written report; interpretation only
The CPT descriptor states that this is a service provided only "by [a] consulting physician;" however, it can be used by a family physician who is consulted by another physician.
- 59070 Transabdominal amnioinfusion, including ultrasound guidance
This code was added to CPT in 2004 for reporting of amnioinfusion.
Dilation and Curettage
- 59160 Curettage, postpartum
Family physicians performing postpartal curettage by suction aspirator or blunt curettage should use this code. This code would be billed with a -78 modifier as it is used only for curettage due to postpartum complications.
- 59200 Insertion of cervical dilator (e.g., laminaria, prostaglandin) (separate procedure)
Family physicians inserting laminaria or PG gel (intracervical or intravaginal) may use this code in addition to any other services provided. For subsequent insertions in the same day, family physicians should use the -76 modifier (repeat procedures). United Healthcare and many other payers will not separately pay for this service. Others will allow payment only if provided more than 24 hours prior to delivery.
Ultrasound
| Extent of Evaluation | Trimester* | Gestation | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Code | Complete maternal/ fetal Evaluation | Detailed Fetal Anatomic Exam | Limited | Follow-up | 1st | 2nd | 3rd | Single or first gestation | Each additional gestation |
| 76801 | X | X | X | ||||||
| 76802 | X | X | X | ||||||
| 76805 | X | X | X | X | |||||
| 76810 | X | X | X | X | |||||
| 76811 | X | X | X | X | X | ||||
| 76812 | X | X | X | X | X | ||||
| 76815 | X | X | X | X | Report once for any number of fetuses | ||||
| 76816 | X | X | X | X | Report separately for each fetus | ||||
Codes 76811 and 76812 for ultrasound with fetal and maternal evaluation plus detailed fetal anatomic examination are usually performed by maternal-fetal medicine specialists on more complex ultrasound machinery than that normally used in a physician practice.
If a patient does not present with a symptom or complaint related to an ultrasound service (i.e., "routine" ultrasound, or ultrasound to determine the sex of the fetus), then third-party payers usually do not cover this service. Payment is the patient's responsibility.
If a patient does not present with a symptom or complaint related to an ultrasound service (i.e., "routine" ultrasound, or ultrasound to determine the sex of the fetus), then third-party payers usually do not cover this service. Payment is the patient's responsibility.
Anesthesia: Maternity Care
Family physicians who provide anesthesia for labor and delivery may use code 64435 if they administer paracervical block anesthesia or 64430 if they administer pudendal block anesthesia. If a single lumbar injection is given for anesthesia, code 62311 is reported. Should a physician provide neuraxial analgesia/anesthesia or general anesthesia, codes from the Obstetric Anesthesia category 01958-01969 describe these services.
Maternity Care Services Provided After Hours
Many family physicians do not realize that services provided on Sunday, holidays, or before 8 a.m. of each day their office is open or after the usual time the office closes can qualify for the addition of the following codes:
- 99050 Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), in addition to basic service
Family physicians may use this code for office services rendered during hours or on days that the office is not otherwise open. Note that this code is not reported for services rendered during regularly available extended hours (see code 99051).
- 99051 Services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service
This code is used to indicate that your practice is offering extended practice hours on a regular basis and that the service was provided during these regularly available times. (Some physicians have been successful in negotiating payment for this code on the basis of cost savings over visits to urgent or emergency care settings.)
Family physicians may use each of the above two codes when appropriate, but most carriers do not pay for these additional codes. However, it never hurts to code them, since it helps build a case at the insurance carrier for future payment. Some carriers do pay for one or both of these additional codes, so it is useful to check with each payer.
Unlisted Maternity Care Services
- 59899 Unlisted procedure, maternity care and delivery
Some family physicians have utilized this code to describe the intrapartum services that they provide to their maternity care patients who receive unusual or new services for which no CPT code has been assigned . However, some carriers will not recognize, nor pay, for this code. Documentation should always be submitted with this code to describe the service provided.
