CPT Code 59400 for Vaginal Delivery & Postpartum

To avoid errors when billing for CPT 59400, consider the following:

• Accurate Documentation: Every prenatal visit, test, procedure, and medical intervention should be recorded. Proper documentation is essential for justifying claims and reducing the risk of denials or audits.
• Understanding the Global OB Package: Many insurance companies use a global billing structure for maternity care, meaning they bundle all routine obstetric services into one payment. CPT code 59400 falls under this category. If a patient changes providers mid-pregnancy or experiences complications requiring extra care, separate billing codes may be necessary.
• Avoiding Unbundling Errors: Some providers mistakenly bill separately for services already included in CPT 59400, which can lead to compliance issues. Only bill additional services if they fall outside routine care, such as ultrasounds, high-risk pregnancy management, or emergency procedures.
• Medical Necessity Compliance: Every service billed must be medically necessary. Ensure that diagnoses, clinical findings, and treatment plans support the need for each service provided. Improper billing can result in claim denials or audits.
• Insurance-Specific Guidelines: Different insurers may have varying rules regarding global maternity billing, reimbursement timing, and coverage for additional services. Understand each payer’s policy helps prevent delays or disputes in payments.