When Maternity Care Begins
Initiation of Global Maternity Care
While payer policies can vary, 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. Maternity care services may be initiated by nonphysician practitioners in some practices.
Services Prior to Intial Maternity Care
Maternity care does not begin if a viable pregnancy has not been confirmed by a healthcare professional. Evaluation and management (E/M) services prior to the start of maternity care are reported with the appropriate E/M codes for the setting (e.g., office or other outpatient E/M codes).
If a patient presents with history of a positive home pregnancy test but pregnancy is not confirmed at the end of the visit, an E/M service may be reported with a diagnosis code to indicate the patient status (e.g., V72.40 - Pregnancy examination or test; pregnancy unconfirmed).
Likewise, pregnancy may be confirmed but maternity care not initiated at that visit. This may occur when a patient presents for a preventive service or other complaint and is found to be pregnant in the course of the encounter. If the pregnancy is an incidental finding of the encounter and initial maternity care is delayed to another visit or to be provided by another physician, report only the services provided (e.g., 99395 - Preventive medicine service, established patient, aged 18-39 years, and 81025 - Urine pregnancy test by vision color comparison methods).
At other encounters, pregnancy may be confirmed but viability is not. For instance, a pregnancy test is positive but the patient is spotting. The patient is referred for an obstetrical ultrasound to check fetal viability. The encounter would be reported with an E/M code and the diagnosis for pregnancy with complications (e.g., 649.53 - Spotting complicating pregnancy).
Naturally, a patient seen with suspected pregnancy found to not be pregnant would not result in the start of maternity care. Such visits should be reported with the E/M code and a diagnosis code that best describes the outcome of the visit (e.g., V72.41 - Pregnancy examination or test, negative result).
If a patient presents with history of a positive home pregnancy test but pregnancy is not confirmed at the end of the visit, an E/M service may be reported with a diagnosis code to indicate the patient status (e.g., V72.40 - Pregnancy examination or test; pregnancy unconfirmed).
Likewise, pregnancy may be confirmed but maternity care not initiated at that visit. This may occur when a patient presents for a preventive service or other complaint and is found to be pregnant in the course of the encounter. If the pregnancy is an incidental finding of the encounter and initial maternity care is delayed to another visit or to be provided by another physician, report only the services provided (e.g., 99395 - Preventive medicine service, established patient, aged 18-39 years, and 81025 - Urine pregnancy test by vision color comparison methods).
At other encounters, pregnancy may be confirmed but viability is not. For instance, a pregnancy test is positive but the patient is spotting. The patient is referred for an obstetrical ultrasound to check fetal viability. The encounter would be reported with an E/M code and the diagnosis for pregnancy with complications (e.g., 649.53 - Spotting complicating pregnancy).
Naturally, a patient seen with suspected pregnancy found to not be pregnant would not result in the start of maternity care. Such visits should be reported with the E/M code and a diagnosis code that best describes the outcome of the visit (e.g., V72.41 - Pregnancy examination or test, negative result).
Coding for Intrapartum and Other Maternity Care
