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The CPT® Code 59430 refers to "Postpartum care only (separate procedure)," which indicates that this code is utilized when a physician provides routine postpartum care as a distinct service. This care is rendered in an office or outpatient setting and is specifically for patients who have undergone either a vaginal or cesarean delivery performed by another healthcare provider who is not part of the same medical group. The term 'routine postpartum care' encompasses a variety of essential follow-up services that may be delivered over one or more visits during the designated global period following the delivery. These services typically include a comprehensive physical examination to assess the mother's recovery, laboratory studies to monitor health parameters, and suture removal in cases of cesarean delivery. Additionally, the postpartum care may involve a pelvic examination to evaluate the healing process, discussions regarding birth control methods to assist in family planning, and counseling on breastfeeding practices and considerations for future pregnancies. This code is crucial for accurately capturing the postpartum care provided by a physician who is not the delivering provider, ensuring proper documentation and billing for these essential services.
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The indications for utilizing CPT® Code 59430 include the following:
The procedure associated with CPT® Code 59430 involves several key steps that ensure comprehensive postpartum care for the patient. Each step is critical in addressing the various aspects of recovery and support needed after childbirth.
Post-procedure care following the services rendered under CPT® Code 59430 includes monitoring the patient's recovery and ensuring that any follow-up appointments are scheduled as necessary. The physician may provide instructions regarding signs of complications to watch for, such as excessive bleeding, signs of infection, or any unusual pain. Additionally, the physician may recommend follow-up visits to continue monitoring the patient's health and to provide ongoing support for breastfeeding and family planning. It is essential for the patient to adhere to any prescribed follow-up care to ensure a smooth recovery and to address any health concerns that may arise during the postpartum period.
| Short Descr | CARE AFTER DELIVERY | Medium Descr | POSTPARTUM CARE ONLY SEPARATE PROCEDURE | Long Descr | Postpartum care only (separate procedure) | 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) | M5D - Specialist - other | MUE | 1 | CCS Clinical Classification | 227 - Other diagnostic procedures (interview, evaluation, consultation) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | FP | Service provided as part of family planning program | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | SA | Nurse practitioner rendering service in collaboration with a physician | SB | Nurse midwife | TH | Obstetrical treatment/services, prenatal or postpartum | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| Pre-1990 | Added | Code added. |
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