Some services that are included in labor management are periodic physical examination, collecting and interpreting physiologic data (uterine contraction monitoring, vital signs and pulse oximetry) and induction/augmentation of labor. These services are considered integral components of labor management and are not separately reimbursable.
Initial day labor management codes should be reported once for the initial day of admission. Subsequent day labor management codes may be reported once per day for each additional day that labor management services are provided during the admission. A delivery code may be reported in addition to the initial or subsequent labor management code when both services are provided on the same date of service.
Once labor management begins, billing E&M codes is no longer appropriate. One exception to this is if the patient is seen in a physician’s office for the onset of labor and is subsequently admitted to the hospital on that same day.
When there are multiple fetuses only one complex labor management code should be reported regardless of the number of fetuses.
Delivery Care
Delivery care services include, but are not limited to, vaginal or cesarean delivery, delivery of the placenta, or simple removal of cerclage. A vaginal delivery begins when the fetus is visible and crowned, while a cesarean delivery begins when the decision is made to perform the cesarean delivery.
Delivery care codes include, but are not limited to:
Vaginal Delivery
- CPT 59431 – Vaginal delivery, with or without episiotomy
- CPT 59432 – Vaginal delivery, after previous cesarean delivery
Cesarean Delivery
- CPT 59502 – Cesarean delivery; primary
- CPT 59503 – Cesarean delivery; repeat
Cesarean-Related Procedures
- CPT 59504 – Subtotal or total hysterectomy after cesarean delivery
When a vaginal delivery is attempted but results in a cesarean delivery, only the cesarean delivery code should be reported.
When a cesarean delivery is performed, the appropriate cesarean delivery code should be reported only once, regardless of the number of fetuses delivered.
A planned cesarean delivery is not considered labor; therefore, a labor management code should not be reported. Because labor management services are not provided when a planned primary cesarean delivery is performed, an E&M code may be reported on the same date of service as the cesarean delivery.
Same-day routine postpartum care is included in the reimbursement for delivery care. However, delivery care and initial or subsequent labor management services may be reported separately when both are provided on the same date of service.
Delivery of the placenta is not separately reimbursable when a vaginal delivery code is reported by a physician or other qualified health care professional of the same specialty and subspecialty within the same group practice. However, delivery of the placenta is separately reimbursable only when performed by a physician or other qualified health care professional who did not perform the vaginal delivery.
For multiple gestations, report one vaginal delivery code for each fetus delivered vaginally and one cesarean delivery code, regardless of the number of fetuses delivered by cesarean delivery. If both a vaginal and cesarean delivery are performed, report one vaginal delivery code for each fetus delivered vaginally and one cesarean delivery code regardless of number of fetuses delivered by cesarean delivery.
Postpartum care
Postpartum care includes ongoing assessments and management tailored to the individual patient's postpartum needs. Reimbursement for postpartum care may be considered when the appropriate E&M code is reported based on the services rendered, a pregnancy-related ICD-10-CM diagnosis code is included on the claim, and the TH modifier is appended.
Routine postpartum care should not be reported on the same calendar date as delivery care.
Inpatient postpartum care provided on a date after the delivery date may be reported using the appropriate E&M code, such as subsequent hospital or observation care (99231-99233), hospital discharge services (99238-99239), or critical care services (99291-99292).
However, maternity delivery services and inpatient postpartum E&M services, including subsequent hospital or observation care (99231-99233), hospital admission and discharge services (99234-99236), or hospital discharge services (99238-99239), should not be reported on the same calendar date.
Outpatient postpartum care provided on a date after delivery may be reported using the appropriate E&M service, including but not limited to office or other outpatient visits (99202-99205 or 99211-99215), telehealth services (98000-98015).
Postpartum care services may include, but are not limited to:
- Postpartum home, office, telehealth, or hospital visits following vaginal or cesarean delivery
- Assessment and management of postpartum recovery and complications
- Contraceptive counseling
- Intrauterine device (IUD) insertion and related follow-up care
- Lactation support and management of lactation-related complications
- Screening, evaluation, and medical management of postpartum depression or other behavioral health conditions
- Suture or incision evaluation and removal, when appropriate
- Other medically necessary postpartum evaluation and management services based on the patient's condition and clinical needs
The following postpartum procedures may be eligible for separate reimbursement when medically necessary:
- 59623 Uterine tamponade (e.g., balloon, catheter, vacuum device, or packing material)
- 59160 Curettage, postpartum
- 59350 Hysterorrhaphy of ruptured uterus
Uterine tamponade is separately reimbursable when performed to manage postpartum hemorrhage. Code 59623 should not be reported for pharmacologic management of postpartum hemorrhage alone.
Multiple Gestations
The specific procedure codes reported will depend on the method of delivery and the number of fetuses delivered.
When reporting multiple gestation vaginal deliveries, report the appropriate vaginal delivery code once per fetus. For multiple gestation deliveries performed via cesarean section, report a single cesarean delivery code, regardless of the number of fetuses delivered.
Refer to the table below for coding guidelines applicable to multiple gestation deliveries. Services must be reported with the appropriate CPT code and modifier, if applicable, to be considered for reimbursement.
