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The CPT® Code 59400 refers to a comprehensive package of routine obstetric care that encompasses antepartum care, vaginal delivery, and postpartum care. This code is utilized when a physician provides a full spectrum of services throughout the pregnancy, delivery, and immediate postpartum period. Antepartum care includes regular prenatal visits where the physician conducts maternal history assessments and physical evaluations to monitor the health of both the mother and fetus. These visits are structured to occur monthly during the first 28 weeks of gestation, biweekly from 28 to 36 weeks, and weekly thereafter until delivery. When labor commences, the patient is admitted to the hospital, where the physician and hospital staff perform an initial assessment. Depending on the labor stage, the patient may be permitted to walk or engage in other activities to facilitate the labor process. As active labor begins, continuous fetal heart monitoring is employed to detect any signs of fetal distress, ensuring the safety of both mother and child. The delivery process typically involves a vaginal birth, which may include an episiotomy if deemed necessary, and the use of forceps or vacuum extraction to assist in the delivery. After the baby is born, the umbilical cord is clamped and cut, and the newborn is evaluated for any immediate care needs. The placenta is also delivered and examined to confirm that all placental tissue has been expelled from the uterus. If an episiotomy or significant vaginal tearing occurs, the physician will suture the area as needed. Post-delivery, the physician continues to provide care by attending to the mother in the hospital and offering postpartum follow-up care. The use of CPT® Code 59400 is appropriate when all these services—antepartum care, vaginal delivery, and postpartum care—are rendered in a comprehensive manner, ensuring a complete continuum of care for the patient throughout the obstetric process.
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The following indications outline the circumstances under which CPT® Code 59400 is applicable, reflecting the comprehensive nature of routine obstetric care:
The procedure associated with CPT® Code 59400 involves several key steps that ensure comprehensive obstetric care:
Post-procedure care following the use of CPT® Code 59400 includes monitoring the mother for any complications that may arise after delivery. The physician will conduct postpartum follow-up visits to assess the mother's recovery, provide guidance on postpartum care, and address any concerns related to the physical and emotional aspects of recovery. This ongoing care is essential to ensure the well-being of the mother and to facilitate a healthy transition into parenthood.
| Short Descr | OBSTETRICAL CARE | Medium Descr | OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | Long Descr | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care | Status Code | Active Code | Global Days | MMM - Maternity Code | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 135 - Forceps, vacuum, and breech delivery |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | U9 | Medicaid level of care 9, as defined by each state | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | CR | Catastrophe/disaster related | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | KX | Requirements specified in the medical policy have been met | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SC | Medically necessary service or supply | U7 | Medicaid level of care 7, as defined by each state | U8 | Medicaid level of care 8, as defined by each state | UB | Medicaid level of care 11, as defined by each state | UD | Medicaid level of care 13, as defined by each state |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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