Are you here to learn the best billing tips for CPT code 59400? Use it for complete maternity care! Global codes are designed to simplify billing. However, their rules can confuse even professional coders, let alone a healthcare provider. There is always an underlying issue of determining which services are included and which are not.
As a result, many providers end up violating the bundling rules and face reimbursement challenges, including late payments and even penalties in severe cases. Want to know the best way to overcome these problems? Gain a thorough understanding of relevant CPT codes, starting with 59400.
CPT Code 59400 – Description
As briefly hinted in the intro, CPT code 59400 is a global service code. It covers all three phases of maternity care for a patient who delivers vaginally, such as:
- Antepartum care (before delivery)
- Vaginal delivery
- Postpartum services
In simple terms, OBGYNs use this single code to bill for multiple obstetric care-related services throughout a patient’s pregnancy, including hospital admission, labor induction and management, vaginal delivery (with or without forceps or episiotomy), inpatient and outpatient postpartum care for up to 6 weeks.
Keep in mind that the typical global maternity care starts with routine prenatal visits during the eighth to tenth week of pregnancy.
Scenarios Where CPT Code 59400 is Applicable
Need some specific scenarios to understand what is covered under CPT code 59400? Pay attention to the following three examples:
Billing for Global Maternity Care, Uncomplicated Vaginal Delivery
Effective maternity care is crucial for a safe delivery. So, for this example, suppose a 25-year-old woman begins her prenatal care at the 8th week of pregnancy. The current U.S. national guidelines recommend 12 to 14 antepartum visits for low-risk pregnancies.
Hence, our patient sees her OBGYN every four weeks until the 32nd week, then every two weeks until the 36th week, and weekly thereafter until delivery. So, what happens during each visit? The healthcare provider evaluates her condition, checks her vital signs, monitors the baby’s growth, and makes necessary medical decisions.
At the 39th week, the provider helps the patient give birth vaginally after spontaneous labor. The same OBGYN then provides postpartum care for six weeks. She then uses CPT code 59400 to bill for all antepartum, delivery, and postpartum services.
Complete Maternity Care Including Vaginal Delivery with Episiotomy
Let’s look at another example. Consider a 36-year-old woman who visits an OBGYN clinic after experiencing pregnancy symptoms. After confirming her pregnancy, the healthcare provider assesses the patient’s overall health and reviews her medical history to determine that this is her third pregnancy.
The OBGYN then outlines a detailed antenatal care schedule, asking the patient to return for monthly routine visits. Since the most common time for labor is around the 39th week, let’s assume that the patient begins experiencing contractions at that point. During the vaginal delivery, the healthcare provider performs an episiotomy to ensure that the baby is delivered safely.
Following birth, the patient attends several postpartum visits where the OBGYN monitors her stitches and provides counseling on postpartum depression. The billing team then uses CPT code 59400 to bill for this global maternity package.
Routine Obstetric Care with Vaginal Delivery via Forceps
Finally, let’s assume a 28-year-old woman attends every prenatal visit since the ninth week of her pregnancy. During each of these visits, her test results are normal. However, at the 39th week, the healthcare provider has to use forceps to grasp the baby to assist the patient with vaginal birth after 12 hours of labor.
The same OBGYN then sees the patient for 6 weeks after vaginal birth to examine her condition and monitor her healing. The provider’s billing team reports every routine service with CPT code 59400.
Applicable Modifiers for CPT Code 59400
The following delivery-related modifiers are usually used with this global service code:
Modifier U7
Did the patient give birth naturally before the 39th week due to medical necessity? Use modifier U7 with CPT code 59400.
Modifier U8
What if the patient is a Medicaid beneficiary in the above scenario? In that case, instead of modifier U7, append modifier U8 to CPT code 59400.
Modifier U9
If the Medicaid beneficiary vaginally delivers a baby at or after the 39th week, apply modifier U9 to CPT code 59400.
Modifier UB
For all spontaneous deliveries between 37 and 39 weeks, use modifier UB with CPT code 59400. You must bill this code with modifier U8 if the patient is a Medicaid beneficiary.
CPT Code 59400 – Billing & Reimbursement Guidelines
Want to avoid common global coding pitfalls, such as incomplete documentation or unbundling? Follow these billing and reimbursement guidelines for CPT code 59400:
Use 59400 for Global Maternity Care
As we have mentioned this quite a few times in this blog, 59400 is a global service code. It means it allows you to bill for multiple routine obstetric services. Hence, you cannot use it to report a single visit or services for related or unrelated complications, such as:
- Yeast infections
- Gestational diabetes or toxemia
Moreover, this code is only applicable when the same provider or the same group practice performs all the components of maternity care.
Apply this Code Only if Maternity Care Includes Vaginal Delivery
Keep one more thing in mind! This global maternity care code includes vaginal delivery (with or without episiotomy/forceps). Hence, avoid using it to report a care package, including a C-section. There is a different code for that, CPT code 59510.
Maintain Complete Documentation
Another important tip for avoiding global billing issues? Maintain complete documentation throughout a patient’s pregnancy. In simple terms? Your records must include each component of maternity care, including:
- All the antepartum visits, including history, physical examinations, and medical decisions
- Delivery report (vaginal, either by episiotomy or forceps, and complications, if there are any)
- Postpartum services, including office visits and evaluations.
Verify Payer Rules
You must do one more thing for quicker reimbursements! Since the global maternity coverage rules can vary significantly from payer to payer, you must verify each insurer’s requirements before filing a claim for CPT code 59400.
Summary
Do you now understand how you cannot use CPT code 59400 to report or bill standalone services? The main reason is that it is a global service code, covering all routine maternity care services. However, it is mainly applicable if obstetric care involves vaginal delivery. So, be very careful with this detail.
We have highlighted all these important points in our blog along with specific modifiers and guidelines to help you bill your services with confidence. For a more efficient reimbursement process, consider partnering with a professional. Just choose one of the top names that provide efficient OBGYN billing services.