How To Use CPT Code 59514

CPT 59514 is a code used for cesarean delivery only, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 59514?

CPT 59514 is a medical billing code used to describe a cesarean delivery procedure, which involves delivering a baby through an incision in the mother’s abdomen and uterus. This code is used by medical coders and billers to report and bill for this specific type of delivery.

2. 59514 CPT code description

The official description of CPT code 59514 is: “Cesarean delivery only.”

3. Procedure

1. The provider admits the patient to the hospital for delivery.
2. An initial history and physical examination are performed to assess the mother’s and fetus’ condition.
3. The patient is taken to the operating room and placed in a supine position.
4. A spinal anesthetic is administered to the patient.
5. The provider makes an incision in the lower abdomen and exposes the lower uterine segment.
6. The bladder is dissected away from the uterus, and a transverse incision is made into the lower uterine segment.
7. The provider ruptures the membranes to release the amniotic fluid and delivers the baby manually, with a vacuum cup, or forceps.
8. A drug is administered to help the uterus contract, and the placenta and membranes are manually removed.
9. The uterine cavity is examined, the uterine wall is closed in one or two layers, and the uterine incision is covered with peritoneum.
10. The abdominal incision is closed, and the provider inspects the cervix and vagina for lacerations, repairs the episiotomy incision if one was made, and repairs any minor vaginal or cervical tears as well.

4. Qualifying circumstances

Patients eligible to receive CPT code 59514 services are those who require a cesarean delivery due to medical reasons, such as a high-risk pregnancy, fetal distress, or a failed labor. This code can be used for both planned and emergency cesarean deliveries, as long as the patient has not had a previous cesarean delivery.

5. When to use CPT code 59514

It is appropriate to bill the 59514 CPT code when a provider performs a cesarean delivery without any antepartum care or postpartum care beyond the date of delivery. This code can be used for both planned and emergency cesarean deliveries, as long as the patient has not had a previous cesarean delivery.

6. Documentation requirements

To support a claim for CPT 59514, the following information needs to be documented:

• Medical necessity for the cesarean delivery
• Date and time of the procedure
• Details of the procedure, including incision type, delivery method, and any complications
• Postoperative care provided on the date of delivery
• Any additional services or procedures performed during the delivery, such as anesthesia administration or laceration repair

7. Billing guidelines

When billing for CPT code 59514, it is important to follow the appropriate guidelines and rules. If the provider performs work greater than normal, modifier 22 (Increased procedural service) can be added to the code, with detailed documentation to support the additional reimbursement. If the provider also provides inpatient postpartum care, they may bill for this in addition. However, if the provider will also be providing outpatient postpartum care, report CPT 59515 instead.

8. Historical information

CPT 59514 was added to the Current Procedural Terminology system on January 1, 1994. The code was changed on January 1, 2010, with the previous descriptor being “Cesarean delivery only.” In 2017, it was added to the Medicare Inpatient Only (IPO) list.

9. Similar codes to CPT 59514

Five similar codes to CPT 59514 and how they differentiate are:

• CPT 59510: Includes antepartum care, cesarean delivery, and postpartum care.
• CPT 59515: Includes cesarean delivery and postpartum care, both inpatient and outpatient.
• CPT 59400: Covers routine obstetric care, including antepartum care, vaginal delivery, and postpartum care.
• CPT 59409: Involves vaginal delivery only, without any antepartum or postpartum care.
• CPT 59410: Includes vaginal delivery and postpartum care, both inpatient and outpatient.

10. Examples

1. A patient with a high-risk pregnancy undergoes a planned cesarean delivery due to concerns for the safety of the mother and baby.
2. A patient in labor experiences fetal distress, and the provider decides to perform an emergency cesarean delivery.
3. A patient with a history of a previous uterine surgery requires a cesarean delivery to avoid potential complications during a vaginal delivery.
4. A patient with a breech presentation undergoes a cesarean delivery to safely deliver the baby.
5. A patient with a transverse lie presentation requires a cesarean delivery to avoid potential complications during a vaginal delivery.
6. A patient with a placenta previa undergoes a cesarean delivery to prevent excessive bleeding during a vaginal delivery.
7. A patient with a failed labor, after attempting a vaginal delivery, requires an emergency cesarean delivery.
8. A patient with a large baby, estimated to be over 4500 grams, undergoes a cesarean delivery to avoid potential complications during a vaginal delivery.
9. A patient with active genital herpes at the time of delivery requires a cesarean delivery to prevent transmission of the virus to the baby.
10. A patient with a history of a previous shoulder dystocia during a vaginal delivery undergoes a cesarean delivery to avoid potential complications.