Global Routine Maternity Care
Family physicians can code most pregnancies with code 59400 for the routine maternity care including vaginal delivery. CPT also includes a code for routine care of patients who deliver by cesarean delivery and two more codes for patients who have previously had a cesarean delivery. The four codes representing routine, global maternity care are:
- 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
- 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
The word routine and the fact that these codes are for use only in situations where one physician provides all three components of the global service indicates the limits of these codes. Family physicians can best understand these "global care codes" by understanding their three component parts: (1) antepartum care; (2) delivery; and (3) postpartum care.
According to CPT, routine antepartum care includes initial and subsequent history, physical exams, recording of weight, blood pressure, fetal heart tones, routine chemical (dipstick) urinalysis, monthly visits up to 28 weeks gestation, biweekly visits between 28 and 36 weeks, and weekly visits until delivery. Under the CPT definition, antepartum care codes do not include more than seven maternity care visits in the first 28 weeks. Instead, the physician should code any other visits (even routine maternity care visits more frequent than once a month) separately. The same applies for biweekly visits between 28 and 36 weeks.
The CPT manual states that delivery services include admission to the hospital, the admission history and physical exam, management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps), or cesarean delivery. Please note that the manual specifically refers to "uncomplicated" labor. If there are any complications, then one should use additional codes.
The CPT manual states that postpartum care includes hospital and office visits following vaginal or cesarean section delivery. Of course, this includes not only the routine post-delivery hospital care offered by a family physician, but also the postpartum visits in the office. However, this code does not include any laboratory services provided at the postpartum visit (e.g., PAP, blood work). It is important to note that only one physician may bill for postpartum care. If both the family physician and a consultant who provided cesarean delivery see the patient postpartum, it must be determined which physician will bill for the postpartum services.
Likewise, family physicians who do not provide cesarean services may find their consultants utilizing the global code, even when the consultant provided no antepartum services. Obviously, this is an inappropriate code for a consultant to use who has not provided antepartum care. Some consultants feel that care of the maternity patient in the hospital before delivery is antepartum care. However, standard coding protocol interprets antepartum care as an out-of-hospital service. Therefore, for an obstetric consultant, who has not provided these services, to use this code is inappropriate. The family physician should work closely with the consultant to make sure the consultant does not make this mistake. The family physician is most often aware of this mistake when denied services for antepartum care, based upon the fact that the third-party payer has paid these services to another physician.
According to CPT, routine antepartum care includes initial and subsequent history, physical exams, recording of weight, blood pressure, fetal heart tones, routine chemical (dipstick) urinalysis, monthly visits up to 28 weeks gestation, biweekly visits between 28 and 36 weeks, and weekly visits until delivery. Under the CPT definition, antepartum care codes do not include more than seven maternity care visits in the first 28 weeks. Instead, the physician should code any other visits (even routine maternity care visits more frequent than once a month) separately. The same applies for biweekly visits between 28 and 36 weeks.
The CPT manual states that delivery services include admission to the hospital, the admission history and physical exam, management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps), or cesarean delivery. Please note that the manual specifically refers to "uncomplicated" labor. If there are any complications, then one should use additional codes.
The CPT manual states that postpartum care includes hospital and office visits following vaginal or cesarean section delivery. Of course, this includes not only the routine post-delivery hospital care offered by a family physician, but also the postpartum visits in the office. However, this code does not include any laboratory services provided at the postpartum visit (e.g., PAP, blood work). It is important to note that only one physician may bill for postpartum care. If both the family physician and a consultant who provided cesarean delivery see the patient postpartum, it must be determined which physician will bill for the postpartum services.
Likewise, family physicians who do not provide cesarean services may find their consultants utilizing the global code, even when the consultant provided no antepartum services. Obviously, this is an inappropriate code for a consultant to use who has not provided antepartum care. Some consultants feel that care of the maternity patient in the hospital before delivery is antepartum care. However, standard coding protocol interprets antepartum care as an out-of-hospital service. Therefore, for an obstetric consultant, who has not provided these services, to use this code is inappropriate. The family physician should work closely with the consultant to make sure the consultant does not make this mistake. The family physician is most often aware of this mistake when denied services for antepartum care, based upon the fact that the third-party payer has paid these services to another physician.
