Code: 59400
Description: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and with or without forceps), and postpartum care
Context: This code is utilized for cases where comprehensive obstetric care is provided. It encompasses the entire spectrum of care from antepartum visits, through the vaginal delivery, to postpartum care.
Guidelines for Proper Use
- Comprehensive Obstetric Care: Apply 59400 for services that include the full range of obstetric care – prenatal visits, management of the delivery, and postpartum care.
- Documentation of Complete Obstetric Service: Ensure that healthcare providers’ documentation reflects all aspects of care covered under this code, including antepartum visits, delivery details, and postpartum follow-up.
- Exclusion of Separate Procedures: Do not use 59400 if individual components of obstetric care (like delivery only or antepartum care only) are provided. In such cases, specific codes for each separate service should be used.
- Vaginal Delivery Inclusive: This code is appropriate for vaginal deliveries only. It includes cases with or without episiotomy and with or without the use of forceps.
- Compliance with Obstetric Guidelines: Use 59400 in accordance with standard obstetric care guidelines and protocols, as well as payer-specific rules for comprehensive obstetric services.
Common Misuses of 59400
- Using for Partial Obstetric Services: A common misuse is applying 59400 to cases where only partial obstetric care is provided, such as only delivery or only antepartum care.
- Application to Non-Vaginal Deliveries: Misuse occurs if 59400 is used for cesarean deliveries or other non-vaginal birth methods.
- Overlooking Separate Billable Procedures: If additional procedures or complications arise that are not covered under the comprehensive care, they need to be billed separately and not included under 59400.
