Obstetrical package: coding and documentation

The global obstetrical package includes all services (antepartum care, delivery, and postpartum care) provided within routine maternity care.

Routine antepartum care consists of periodic evaluation and management of pregnancy, including prenatal history and physical examinations following the initial diagnosis of pregnancy; obtaining and recording of weight, blood pressures, fetal heart tones; and routine chemical urinalysis. Routine visits occur every four weeks until 28 weeks, biweekly until 36 weeks, then weekly until delivery. These visits typically result in approximately 13 office visits.

Delivery services include admission to the hospital, admission history and physical, management of labor, and delivery, whether vaginal (with or without episiotomy, with or without forceps), cesarean, or vaginal birth after cesarean.

Postpartum services include initial inpatient postpartum care and subsequent office or other outpatient visits following vaginal or cesarean section delivery. There may be more than one postpartum visit for routine evaluation and care.

The CPT® manual identifies and describes the following codes as global maternity services:

• 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

Prenatal, delivery, and/or postpartum services billed separately

There are several circumstances when performing prenatal, delivery, and postpartum services does not result in global billing.

In these situations, the maternity services may be separately billable with individual maternity service codes.

The most common scenarios occur:

• When more than one care provider or practice performs maternity services during the global period.
• When more than one payer provides maternity benefits during the global period.
• When prenatal care is initiated late.
• When the pregnancy ends early.

Coding and documentation

CPT defines maternity-related services as:

Quality reporting

To better understand the timing and delivery of perinatal (prenatal and postpartum) services to New York State (NYS) Medicaid members and Medicaid Managed Care (MMC) enrollees, additional information is needed from NYS Medicaid care providers.

Effective for service delivered as of July 1, 2024, care providers using bundled/global procedure codes for billing will also be required to submit claims with non-payment Category II Current Procedural Terminology (CPT) codes for perinatal services to NYS Medicaid fee-for-service (FFS) and MMC. The bundled/global bill procedure codes are 59400, 59410, 59510, 59515, 59610, 59614, 59618, 59622, 59426, and 59425.

Effective July 1, 2024, care providers are required to submit a claim with a Category II CPT code for each prenatal/postpartum service provided to an NYS Medicaid member when the care provider is billing using the global bill codes or a bundled bill. These Category II CPT code claims are in addition to the global or bundled code claims. Claims for NYS Medicaid FFS members must be submitted directly to NYS Medicaid. Claims for MMC enrollees must be submitted to the MMC plan of the enrollee. Additionally, the following Category II CPT codes must be used:

• 0500F initial prenatal visit
• 0502F subsequent prenatal visit
• 0503F postpartum visit

Diagnosis coding

For diagnosis coding, use ICD-10-CM code range of O00-O9A with sequencing priority over codes from other categories.

Additional codes can be used from other categories in conjunction with maternity codes to further specify the condition(s).

Should the care provider specify that the pregnancy is incidental to the encounter, ICD-10-CM code Z33.1 (pregnancy state, incidental) should be used in place of ICD-10-CM codes O00-O9A. Include the condition being treated and document that it is not affecting the pregnancy.

Obstetrics first-listed diagnosis

For routine outpatient prenatal visits when no complications are present, a code from category Z34 (encounter for supervision of normal pregnancy) should be used as the first-listed diagnosis. These codes are not to be used with the O00-O9A category codes.

Prenatal outpatient visits for high-risk patients

For outpatient routine prenatal visits for high-risk pregnancies, use an ICD-10-CM code from category O09 (supervision of high-risk pregnancies) as the first listed diagnosis. Secondary codes can also be used to further describe the patient’s condition.

Claims submission tips:

• An initial visit confirming the pregnancy is not a part of global maternity care services.
• A global charge should be used for one physician or multiple physicians within the same group (tax identification) and provide all components of the patient’s maternity care, which include: four or more antepartum visits, delivery, and postpartum care.

Documentation should specify:

• Patient’s pregnancy by week of gestation.
• Patient’s first or subsequent pregnancy.
• Gestational week(s) and day(s) (for example, 30 weeks, three days) complications developed.
• Reason pregnancy is high-risk (for example, elderly gravida, poor prenatal history).
• Underlying or pre-existing conditions (for example, hypertension, diabetes, anemia).
• Control of gestational diabetes (for example, diet, insulin).
• Fetal condition affecting management of pregnancy and trimester.
• Multiple fetuses:
• Condition(s) affecting some or all the fetuses.

References

ICD-10-CM. 2024, Optum

CPT. 2024, American Medical Association