Gestational age required for professional delivery claims effective November 1, 2018
To better assess measures of quality for our members, we will begin requiring documentation of a newborn’s gestational age at the time of delivery for all physician delivery claims.
Beginning with dates of service on and after November 1, 2018, all professional delivery claims (59400, 59409, 59410, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620 and 59622) will require an ICD-10 Z3A code indicating the newborn’s gestational age at the time of delivery. If the code is not found on the claim, the claim will be denied with the following reason: “Delivery diagnoses incomplete without report of pregnancy weeks of gestation. You may resubmit the corrected claim with the appropriate ICD-10 code for payment.”