In this post, we discuss coding for global obstetric care in CPT. You will learn about the global maternity package and what’s included (and excluded), the related coding guidelines, and when and how to code for all components and only a portion of them. We also explain how to code for twin delivery and provide a great quiz at the end to test your knowledge.
The Goal of Routine Obstetric Care
Pregnancy and childbirth are exciting times in a woman’s life, but they can also be vulnerable and overwhelming. Getting quality routine obstetric (OB) care can undoubtedly reduce stress. The goal of obstetric care is to provide quality care throughout pregnancy, childbirth, and the postnatal period to ensure the health of the mom and the baby. Before becoming pregnant, physicians recommend that a woman see an obstetrician to manage her health and control any complications throughout the pregnancy and delivery.
CPT Coding Guidelines for Global Obstetric Care
Routine obstetric care services are billed as a global maternity (total obstetric) package when the services are related to antepartum (prenatal) care, uncomplicated delivery services (vaginal or cesarean), and postpartum care. There are also situations in which parts of the global package are unbundled.
The CPT codes and guidelines related to obstetric care are found in the Surgery section under the Maternity Care and Delivery subsection. These codes describe the services pertaining to antepartum care, delivery services, and postpartum care in uncomplicated maternity cases.
Antepartum care includes the initial prenatal history and physical examination; subsequent prenatal history and physical examinations; recording of weight, blood pressures, fetal heart tones, routine chemical urinalysis, and monthly visits up to 28 weeks gestation; biweekly visits to 36 weeks gestation; and weekly visits until delivery (about 13 visits). Any other visits or services within this time period that are related to complicated maternity care or unrelated problems treated by the physician should be coded and billed separately.
Delivery services include admission to the hospital, the admission history and physical examination, management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps), or cesarean delivery.
Delivery and Postpartum services include delivery services and all inpatient and outpatient postpartum services.
All Components of the OB Global Package By Same Provider
When all components of the OB global delivery package are provided by the Same Group Physician and/or Other Health Professional, the coder should report these services with CPT codes 59400, 59510, 59610, and 59618. These codes are based on the type of delivery.
- 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
CPT codes 59400 and 59610 are both vaginal delivery codes and include episiotomy and/or the use of forceps. Therefore, when an episiotomy is performed, or forceps are included, they are not reported separately.
An episiotomy is an incision made in the perineum (the tissue between the vaginal opening and the anus). According to the Mayo Clinic, forceps are sometimes used to help guide the baby out of the birth canal.
Codes 59510 and 59618 are both cesarean delivery codes. Vaginal delivery after previous cesarean delivery is often abbreviated in the record as VBAC (vaginal birth after cesarean) or VBACS (vaginal birth after cesarean section).
Part of the OB Global Package
When a physician provides only a portion of the global routine obstetric care, the code for that portion of the service is reported. Reasons for this may vary. It may be that the patient’s coverage didn’t start until after pregnancy, or the coverage was terminated before delivery.
Other reasons may be that the pregnancy did not result in delivery, another provider from a different practice assumed the patient’s care before the completion of global services, or there was a change in the patient’s benefits package during the pregnancy.
Per the CPT coding guidelines,
If all or part of the antepartum and/or postpartum care is provided except delivery due to termination of pregnancy by abortion or referral to another physician or other qualified health care professional for delivery, see the antepartum and postpartum care codes 59425, 59426, and 59430.
Antepartum Only Codes
- Appropriate E/M code, Antepartum care only; 1-3 visits
- 59425, Antepartum care only; 4-6 visits
- 59426, Antepartum care only; 7 or more visits
Delivery Only Codes
- 59409, Vaginal delivery only (with or without episiotomy and/or forceps)
- 59514, Cesarean delivery only
- 59612, Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps)
- 59620, Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery
Delivery and Postpartum Only Codes
- 59410, Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care
- 59515, Cesarean delivery only; including postpartum care
- 59614, Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care
- 59622, Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care
Postpartum Only Codes
59430, Postpartum care only (separate procedure)
Postpartum care only services include office or other outpatient visits following vaginal or cesarean section delivery.
When a physician provides global obstetric care and delivers twins, the same codes are reported as if they are for a single birth. However, modifier -51 (Multiple procedures) should be appended to show an additional delivery.
For example, if a physician delivers both twins vaginally, 59400 is reported for Twin A, and 59401-51 is reported for Twin B.
If a physician delivers both twins by cesarean section, report 59510 (Cesarean delivery) or 59618 (Cesarean delivery following attempted vaginal delivery after previous cesarean delivery), depending on the situation. There is no need to append modifier -51 here because only one cesarean was performed.
If, however, one twin is delivered vaginally and one twin is delivered by cesarean section, the coder would assign 59510 (Cesarean delivery) for the first twin, followed by 59409-51 [(Vaginal delivery only (with or without episiotomy and/or forceps)] for the second twin.
Codes reported with modifier -51 are always assigned as additional codes and are never primary.
Services Excluded from the Global Package
Many antepartum services that are medically necessary are not included in the global obstetric package. For example, BlueCross BlueShield of NC provides an extensive list of services that may be reimbursed outside the global package. They include, among others, initial office visit for confirmation of pregnancy, pregnancy test, amniocentesis, fetal stress test, medically necessary diagnostic fetal ultrasound tests.
According to the coding guidelines,
Pregnancy confirmation during a problem oriented or preventive visit is not considered a part of antepartum care and should be reported using the appropriate E/M service codes 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99384, 99385, 99386, 99394, 99395, 99396 for that visit.