Many mothers suffer from postpartum depression (PPD). It is a prevalent and crippling mental illness. PPD is thought to affect 10-20% of women, which makes it a serious public health issue. The physical, emotional, and psychological health of both the mother and the child depends on maternal care throughout this stage.
To help these women, many OBGYN experts offer only postpartum care services. However, we will discuss how they bill their services using the unique CPT code 59430. You should read this blog if you are an OBGYN practitioner who is having trouble charging for your postpartum-only services.
CPT Code 59430 – Description
CPT code 59430 is used to bill only postpartum care services rendered for one or more visits up to six weeks following delivery.
Postpartum care focuses on recovery from childbirth provided by any physician or non-physician healthcare practitioner. This care may include psychological, emotional, and physical support intended to ensure the mother’s and the newborn’s well-being and proper adjustment throughout the postnatal period.
Therefore, this code covers follow-up visits, physical examinations, counseling, and immunizations after childbirth.
Scenarios Where CPT Code 59430 is Applicable
Let’s check out some scenarios for the correct application of CPT code 59430.
Delivery by Other Physician
Let’s say a 29-year-old woman arrives for an emergency delivery, but her physician is not available at that time. So another physician available on the spot performs the cesarean section. After getting discharged, the patient returns to see her usual OBGYN for postpartum rehabilitation.
Over the following six weeks, her physician performs several postpartum examinations. She assesses the patient’s incision site, tracks uterine involution, talks about breastfeeding methods, and offers emotional support for postpartum anxiety during these sessions. CPT code 59430 is appropriate for these services because the physician just provided postpartum care and did not perform the C-section delivery.
Delivery by a Midwife
Imagine a certified nurse-midwife delivers a baby at a birthing center. The woman whose baby was delivered preferred to visit a professional health care provider for follow-up care. The physician conducted several postpartum visits, assessing the mother’s recovery progress and checking her post-delivery physical and emotional state. The postpartum care visits lasted up to six weeks. Because the delivery was performed by a midwife and the physician was involved in postpartum care only, CPT code 59430 applies for accurate billing.
Emergency Delivery in Another State
Suppose a woman in her third trimester was travelling out of town with her family. However, in the middle of her journey, she experienced early labor and had to deliver her baby in an emergency at a local hospital.
When she returned home, she went to her primary OBGYN for postpartum follow-ups. The physician managed her postpartum recovery by evaluating her physical health and addressing lactation issues. Since her primary physician did not participate in the emergency vaginal delivery but took over the postpartum care management, he can bill his services with CPT code 59430.
Applicable Modifiers for CPT Code 59430
CPT code 59430 is self-explanatory, and therefore, modifiers are rarely applicable to this code. However, one modifier that some payers may want you to use is:
Modifier TH
This modifier indicates that the service is obstetrical in nature, either prenatal or postpartum. So, you can use modifier TH with the postpartum care code 59430 if you are billing your state Medicaid and their policy allows it, as in the case of Texas Medicaid.
CPT Code 59430 – Billing & Reimbursement Guidelines
Let’s discuss some important billing and reimbursement guidelines for CPT code 59430.
Bill Only Once in Six Weeks
Regardless of the number of visits you have with the patient for postpartum care (lasting 6 weeks), you must report this code only once for reimbursement. Meaning, that even if you saw the patient 6 times in 6 weeks (every week), you can only file one claim with CPT code 59430 and collect the payment once for the 6 visits.
Include Comprehensive Documentation
Having the right documentation will prevent your claim from being rejected. Therefore, the most crucial thing your paperwork needs to show is the service’s medical necessity using ICD-10 codes. After that, you need to include the patient’s medical history and additional information like:
- Visit dates
- Postpartum assessment results
- Duration of the counseling (mention weeks or days)
- Subject matters discussed during counseling
- Evidence of no earlier postpartum billing for global or delivery care
When your paperwork is complete, accurate, and comprehensive, the likelihood of being denied is extremely low.
Apply Correct Modifier (When Needed)
There are not many modifiers that would work well with this code, as it exclusively offers postpartum care. Hence, you have to be extra cautious while applying modifiers to CPT code 59430. On the other hand, postpartum care services provided are indicated by the modifier TH. This modifier applies to E/M codes. However, certain insurance payers (like WellCare) do allow the use of the modifier TH with this code (59430-TH).
Follow the Payers’ Policies
Insurance payers have established certain guidelines for medical billing. Each payer reimburses a medical service based on their set policies. Referring to the conversation in the heading above, where a certain insurance company allows the modifier, we strongly advise medical billers to review their payers’ policies before submitting a claim.
Final Word
We hope by now you know that CPT code 59430 does not cover the global package services. It is only used to bill postpartum care services. So, you can use this code in situations where another obstetrician performs delivery and the primary OBGYN provides postpartum care. Additionally, you must adhere to the aforementioned billing and reimbursement guidelines, being especially careful with modifiers.
If this information does not clarify how this code should be billed, you can always opt for professional OBGYN billing services. These services are provided by skilled coders and experienced staff to resolve your medical billing issues.
