cpt 59400, cpt code 59400, 59400 cpt code

How To Use CPT Code 59400

CPT 59400 refers to routine obstetric care, including antepartum care, vaginal delivery, and postpartum care. This article will discuss the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 59400.

1. What is CPT 59400?

CPT 59400 is a code used to describe routine obstetric care, which encompasses antepartum care, vaginal delivery (with or without episiotomy and/or forceps), and postpartum care. This code is utilized by healthcare providers to bill for the comprehensive care provided to pregnant patients throughout their pregnancy, delivery, and post-delivery period.

2. 59400 CPT code description

The official description of CPT code 59400 is: “Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care.”

3. Procedure

The 59400 procedure involves several stages, including:

  1. Antepartum care: Regular prenatal visits, monitoring of maternal and fetal health, estimation of gestational age, identification of potential complications, and patient education.
  2. Intrapartum care: Management of labor, including admission to the hospital, labor induction, fetal monitoring, use of low forceps and episiotomy, and vaginal delivery of the fetus and placenta.
  3. Inpatient postpartum care: Monitoring of vital signs, pain management, patient diet, and ambulation, as well as follow-up visits until discharge.
  4. Outpatient postpartum care: Ongoing evaluation of the mother’s physical and mental status, physical examination, lactation and nutrition counseling, birth control options, immunizations, and collection of a screening Pap smear specimen if necessary.

4. Qualifying circumstances

Patients eligible to receive CPT code 59400 services are pregnant women who require comprehensive obstetric care throughout their pregnancy, delivery, and post-delivery period. This includes patients with low-risk pregnancies as well as those with potential complications that may require additional monitoring and intervention.

5. When to use CPT code 59400

It is appropriate to bill the 59400 CPT code when a healthcare provider has provided all aspects of routine obstetric care, including antepartum care, vaginal delivery, and postpartum care. This code should not be used if the provider has only performed a portion of the comprehensive care or if the patient has undergone a cesarean delivery.

6. Documentation requirements

To support a claim for CPT 59400, healthcare providers must document the following information:

  • Comprehensive initial history and physical examination of the mother
  • Details of antepartum care, including the number and dates of visits, maternal and fetal assessments, and any interventions or referrals
  • Intrapartum care, including labor management, delivery method, and any complications or interventions
  • Inpatient and outpatient postpartum care, including follow-up visits, physical examinations, and any additional services provided

7. Billing guidelines

When billing for CPT code 59400, healthcare providers should be aware of the following guidelines and rules:

  • Use modifier 52 (Reduced services) if the provider has performed less than the requirements for global care, such as fewer antepartum visits or absence during labor management or delivery.
  • Use modifier 22 (Increased procedural services) if the provider has performed work greater than normal, such as additional antepartum visits due to complications or increased labor management or delivery work. Detailed documentation is required for additional reimbursement.

8. Historical information

CPT 59400 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 59400

Five similar codes to CPT 59400 and how they differ are:

  • CPT 59409: Vaginal delivery only (with or without episiotomy and/or forceps); does not include antepartum or postpartum care.
  • CPT 59410: Vaginal delivery only, including postpartum care; does not include antepartum care.
  • CPT 59425: Antepartum care only; does not include delivery or postpartum care.
  • CPT 59426: Antepartum care only for a specific number of visits; does not include delivery or postpartum care.
  • CPT 59430: Postpartum care only; does not include antepartum care or delivery.

10. Examples

Here are 10 detailed examples of CPT code 59400 procedures:

  1. A low-risk pregnancy with regular antepartum visits, a vaginal delivery without complications, and routine postpartum care.
  2. A pregnancy with gestational diabetes requiring additional antepartum monitoring, a vaginal delivery with episiotomy, and postpartum care including diabetes management.
  3. A pregnancy with a breech presentation that spontaneously corrects before delivery, resulting in a vaginal delivery with forceps assistance and routine postpartum care.
  4. A pregnancy with preeclampsia requiring close antepartum monitoring, induction of labor, vaginal delivery, and postpartum care including blood pressure management.
  5. A twin pregnancy with regular antepartum visits, a vaginal delivery of both babies without complications, and routine postpartum care.
  6. A pregnancy with a history of preterm labor requiring additional antepartum visits and interventions, a full-term vaginal delivery, and postpartum care including monitoring for signs of postpartum depression.
  7. A pregnancy with placenta previa that resolves before delivery, resulting in a vaginal delivery without complications and routine postpartum care.
  8. A pregnancy with a history of recurrent miscarriages requiring close antepartum monitoring, a vaginal delivery without complications, and postpartum care including emotional support and counseling.
  9. A pregnancy with a maternal history of hypertension requiring additional antepartum visits and blood pressure management, a vaginal delivery without complications, and postpartum care including continued blood pressure monitoring.
  10. A pregnancy with a fetal growth restriction requiring close antepartum monitoring, a vaginal delivery with episiotomy, and postpartum care including lactation support and counseling.

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