How To Use CPT Code 59515

CPT 59515 describes the procedure for cesarean delivery, including postpartum care. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 59515?

CPT 59515 can be used to describe the global service for cesarean delivery, which includes admission to the hospital, the surgical procedure, and inpatient and outpatient postpartum care. This code is used when the provider performs a cesarean delivery via an abdominal incision and provides postpartum care to the patient.

2. Official Description

The official description of CPT code 59515 is: ‘Cesarean delivery only; including postpartum care.’

3. Procedure

1. The provider admits the patient to the hospital for a planned or emergency cesarean delivery.
2. The provider performs an initial history and physical examination to assess the mother’s and fetus’ condition.
3. The patient is taken to the operating room, and the provider performs the cesarean delivery by making an incision in the lower abdomen and delivering the baby manually, with the assistance of vacuum cup or forceps if necessary.
4. The provider administers a drug to help the uterus contract and manually removes the placenta and membranes.
5. The provider inspects the cervix and vagina for lacerations and repairs any incisions or tears.
6. The patient is transferred to recovery, and the provider provides postpartum care including monitoring vital signs, pain management, patient diet, and ambulation.
7. The provider visits the patient several hours after delivery and follows up with additional visits until the day of discharge.
8. Outpatient postpartum care includes ongoing evaluation of the mother’s physical and mental status, physical examination, discussion of lactation, nutrition, exercise, birth control options, immunizations, and collection of a screening Pap smear specimen if necessary.

4. Qualifying circumstances

CPT 59515 is used for cesarean deliveries, whether planned or emergency, for patients who have not had a previous cesarean delivery. The procedure includes admission to the hospital, the surgical delivery of the fetus and placenta via an abdominal incision, and inpatient and outpatient postpartum care.

5. When to use CPT code 59515

CPT code 59515 should be used for cesarean deliveries that do not involve a previous cesarean delivery. It is appropriate to bill this code when the provider performs the entire procedure, including admission, surgical delivery, and postpartum care. If the patient has had a previous cesarean delivery, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT 59515, the provider must document the following information:

• Reason for the cesarean delivery
• Details of the surgical procedure, including the incision, delivery method, and any repairs made
• Postpartum care provided, including vital signs, pain management, patient diet, ambulation, and any complications or additional treatments
• Details of the outpatient postpartum care, including physical examination findings, discussions with the patient, and any additional tests or procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 59515, ensure that the procedure meets the criteria for a cesarean delivery and includes postpartum care. Modifier 22, Increased procedural service, can be added to CPT 59515 if the provider performs work greater than normal. It is important to provide detailed documentation to support the use of this modifier. CPT code 59515 should not be reported with other codes for cesarean deliveries or postpartum care.

8. Historical information

CPT 59515 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient presents for a planned cesarean delivery, and the provider performs the procedure and provides postpartum care.
2. A patient presents in labor, but the labor fails, and the provider performs an emergency cesarean delivery and provides postpartum care.
3. A patient presents for a planned cesarean delivery after a previous vaginal delivery, and the provider performs the procedure and provides postpartum care.
4. A patient presents for a planned cesarean delivery after a previous cesarean delivery, and the provider performs the procedure and provides postpartum care.
5. A patient presents for a planned cesarean delivery, and the provider performs the procedure and provides postpartum care, including outpatient visits up to six weeks following delivery.