What Services are Included with Billing Global Maternity Care Code 59400?

One significant role of a midwife is providing mothers with quality of health services. It is our duty to provide them with proper care and comfort making sure that their pregnancy journey will be a memorable one. There are many more maternal billing and coding challenges that you may encounter much especially during this pandemic. You’ve got to figure out a way to provide prenatal checkups, physical exams, annual well checks, and vaccinations because both your patient’s health and your practice’s revenue are at stake.

Global maternity care includes pregnancy-related antepartum care, admission for labor and delivery care, management of labor including fetal monitoring, delivery, and uncomplicated postpartum care until six weeks postpartum. When billing for maternity care, it is crucial to understand the Global Obstetrical Package. Currently, global obstetrical care is defined by the AMA CPT as “the total obstetric package includes the provision of antepartum care, delivery, and postpartum care.” (Source: AMA CPT codebook 2022, page 440.) All services must be provided by a provider with all of the patient’s routine obstetric care, which includes the antepartum care, delivery, and postpartum care.

Global Billing with CPT Code 59400-59618 Includes These Services
The Global OB package covers patient care during the entire pregnancy — the antepartum period, delivery, and postpartum. Providers get paid a flat rate for the services rendered under these CPT global obstetric codes:

• 59400 – Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care
• 59510 – Routine obstetric care including antepartum care, cesarean delivery and postpartum care
• 59610 – Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care, after previous cesarean delivery
• 59618 – Routine obstetric care including antepartum care, cesarean delivery and postpartum care, following attempted vaginal delivery after previous cesarean delivery

When billing with the global OB codes, front desk staff, coders and billers need to be aware of visits and services that aren’t part of routine maternity care. This allows schedulers to provide accurate information on possible patient costs and billers to charge separately. Proper global package code selection is essential to receive the maximum allowed reimbursement. There are times when one code might be paid but using the correct code will bring higher insurance payment. For example, if a patient has a cesarean delivery after an unsuccessful attempt at a vaginal delivery, code 59510 (Routine obstetric care including antepartum care, cesarean delivery and postpartum care, 67.00 relative value units) is in order. 
 
However, if this same scenario transpires after a prior cesarean delivery, 59618 (Routine obstetric care including antepartum care, cesarean delivery and postpartum care, following attempted vaginal delivery after previous cesarean delivery, 67.88 RVUs) is the proper code to use.

CPT Code 59400 Includes Only Uncomplicated Services
It’s important to note, global maternity billing covers services under normal, uncomplicated conditions. Global maternity billing does not cover:

• Problems that aren’t related to pregnancy, such as yeast infections
• Services for pregnancy complications, such as gestational diabetes or toxemia
• Extra visits for a high-risk pregnancy
• Procedures, such as ultrasounds and amniocentesis

Instead, the provider would separately bill these services at the time of treatment.

Insurers Vary on CPT Code 59400 Billing, Payment Schedule, Duration
Global billing for maternity care is beneficial to both patient and provider when the pregnancy follows an uncomplicated course. Some variables, however, can complicate matters for the provider’s revenue cycle. Considering the global maternity billing package spans a nine-month period, that’s a big window to wait for reimbursement. Variables to consider with insurance companies when billing for global maternity services are:

• Not all insurance companies handle global maternity billing the same way.
• Not all insurers pay providers at the same interval. Some pay at the start of the pregnancy while others pay after the final postpartum visit is complete.
• Insurers differ on the coverage of specific services and duration of the global pricing bundle.

CPT Code 59400 Doesn’t Always Apply 
The CPT OB bundles are billed for and reimbursed when all services are rendered by a single providers or multiple providers from the same group. There are some situations that complicate global maternity billing and require the provider to bill the delivery, antepartum, and postpartum separately. These include when a:

• patient must change insurance providers or doctors during her pregnancy
• patient’s baby is delivered by someone other than her provider or another provider in a group practice
• patient has a voluntary or involuntary pregnancy termination

 
Global Maternity Care Code Quick Reference Guide
https://www.bcbsnd.com/content/dam/bcbsnd/documents/general/Global-Maternity-Quick-Reference-Guide.pdf
 
References
1, P. O. (2022, April 1). CPT code 59400 Global Maternity Billing You Need To Know. Healthcare Training Leader. Retrieved May 30, 2022, from https://healthcare.trainingleader.com/2019/10/cpt-code-59400/