Can you append modifiers with global code? This blog answers you list of questions regarding this code. Additionally it provides billing and reimbursement gudielines to save you from facing a denial on this code. So lets end the curiosity. There are various CPT codes that the physicians may use to bill their specific services during pregnancy, delivery, and postpartum care. However, is there a complete code that addresses everything from prenatal care to post-delivery complications? Indeed, there is! CPT code 59510 is a global service code that pertains to cesarean birth but covers all pre-, intra-, and post-delivery services.
So, how is this code billed? Which circumstances could result in a surgical delivery? Let’s find the answers in this blog.
CPT Code 59510 – Description
CPT code 59510 refers to a global service. The global nature of the 59510 CPT code means that all services performed during the maternity cycle are reported and reimbursed together to improve revenue cycle management for healthcare practices. During this process, the physician provides a complete package of routine obstetric care, including,
- Antepartum care (prenatal checkups, regular evaluations, and pregnancy-long monitoring).
- Cesarean delivery (delivering a baby through an abdominal and uterine incision).
- Postpartum care (after-delivery care that usually lasts six weeks).
Typically, these services start at 8 to 10 weeks of gestation, include a full-term cesarean birth at 39 to 40 weeks of gestation, and normal inpatient and outpatient postpartum care with one or more visits up to six weeks after delivery.
Scenarios Where CPT Code 59510 is Applicable
Let’s discuss some real-life examples where the gynecologist can apply CPT code 59510.
High-Risk Pregnancy with Full Care
High-risk pregnancies are fatal for the mother and the fetus, so they require extra care and attention. Among all other pregnancies, 6-8% of women experience this problem.
Suppose a 38-year-old obese woman conceives and takes a pregnancy test, which turns out to be positive. She visits her gynecologist for further treatment. The physician finds out that due to obesity and high blood pressure, this could result in a high-risk pregnancy. The patient needs extra medical care before, during, and after birth.
The gynecologist provides services, from antepartum care to postpartum treatment, to reduce the possibility and severity of complications. Due to the severity of the case, the physician performed a C-section delivery. Hence, she can bill her services with the CPT code 59510.
Placenta Previa Diagnosis and Delivery
Suppose a woman was getting her routine pregnancy treatment from her gynecologist. However, the moment she hit her second trimester, she started having vaginal bleeding. She immediately went to see her gynecologist, and her physician suspected placenta previa. She ordered an ultrasound to monitor this problem.
After regular analysis of her placenta previa in the second and third trimesters, the physician decided to go for the safest delivery option, which is cesarean delivery. Due to the complex delivery, the gynecologist also provided postpartum care for 6 weeks to the patient. Therefore, she can bill all her services under one global code, which is CPT code 59510.
Maternal Health Conditions Requiring Cesarean
Suppose a 36-year-old woman is pregnant with various health complications. She is a polycystic ovary syndrome (PCOS) patient with heart disease, which increases the health risk in both the woman and the fetus. So after the necessary antepartum care, the OBGYN tells her that he will perform a C-section because her heart issues can worsen during vaginal birth or may affect the health of the fetus. Since postpartum care was also rendered up to 6 weeks after surgical delivery, all the services will be billed with one global code – CPT code 59510.
Applicable Modifiers for CPT Code 59510
The service provider may apply the following modifiers with CPT code 59510.
Modifier 22
This modifier indicates increased procedural services. In the instance of CPT code 59510, if the C-section involved more work than the standard, then this may be reported via modifier 22.
Modifier 52
In contrast, modifier 52 refers to reduced procedural services. The physician may apply this modifier with CPT code 59510 in case of fewer patient visits or less complicated follow-up care. However, you must keep in mind that this modifier may reduce your payment.
CPT Code 59510 – Billing & Reimbursement Guidelines
The following billing best practices will help you file clean and compliant claims for CPT 59510.
Ensure Accurate Use of 59510
When billing with this code, it is essential to be aware that it only covers the global services related to obstetric care. You can apply CPT code 59510 when the same practitioner is in charge of the entire obstetric care package, which includes prenatal, birth, and postpartum care, and delivery via C-section. However, if different physicians were involved through phases of care or other unrelated services were provided, then 59510 cannot be used for billing and reimbursement.
Provide Proper Documentation
Proper documentation serves as the backbone for billing and reimbursements. Insurance payers want you to submit precise ICD-10 diagnostic codes together with essential documentation as proof of medical necessity.
Missing or incorrect diagnosis codes may lead to claim denials and payment delays. Additionally, the following information should be noted specifically for CPT code 59510:
Antepartum Care
- Number of visits and date of each visit
- Maternal vital signs and fetal monitoring results
- Laboratory and imaging findings
- Risk assessment and prenatal counseling
Cesarean Delivery
- Indication for C-section
- Type of anesthesia used
- Surgical technique used
- Mention any complications
- Time and date of delivery
- APGAR scores and neonatal condition at birth
Postpartum Care
- Mother’s recovery progress
- Incision healing and any complications
- Breastfeeding status and lactation counseling
- Family planning discussion
- Postpartum depression screening
Follow Payers’ Specific Policies
Every insurance payer covers the global maternity care services in their own way. Hence, providers need to confirm the insurance policies. You must carefully review the coverage policies of the respective insurance payer for individual prenatal or postpartum visits.
Final Word
CPT code 59510 refers to regular obstetric care, including prenatal care, cesarean delivery, and postpartum care. C-section birth is the result of a few uncommon situations, such as high-risk pregnancies, placenta previa, or other maternal health issues. Because this code is global, you must use caution while applying modifiers. Finally, you must submit claims in accordance with the payer’s policies and provide accurate documentation to support the need for those services.
Or you can simplify your workload by opting for professional OBGYN billing services. Service stacks like these include precise coding and billing for obstetric global codes, like the one covered in this detailed guide.
