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Payment of delivery and Postpartum Care
E/M codes may not be used when reporting postpartum visits and will be denied. Effective 6/27/11, Providers must bill a delivery code that includes the postpartum visit when the physician intends to provide postpartum care. The CPT® codes that include delivery and postpartum care are:
- 59410: Vaginal delivery including postpartum care
- 59515: Cesarean delivery including postpartum care
- 59614: Vaginal delivery after previous cesarean delivery including postpartum care
- 59622: Cesarean delivery following attempted vaginal delivery after previous cesarean delivery including postpartum care.
When these CPT® codes are billed on the date of delivery, the provider is paid in advance for the postpartum care. The postpartum visit must occur within 21 to 56 days after the date of delivery. The actual postpartum service, once rendered, must be billed in order to avoid a retraction. To bill the postpartum visit use the CPT® code that was originally billed on the date of the delivery but add modifier TH (i.e., 59410TH, 59515TH, 59614TH, 59622TH). The date of service of the postpartum visit must also be reported when the TH modifier is used. The diagnosis codes on postpartum claims should reflect one of the following: V24.1, V24.2, V25.1, V72.3, and V76.2. This visit is paid at $0 since the postpartum payment was included in the delivery payment.
The TH modifier indicates that the prepaid postpartum visit was performed as originally intended, meets HEDIS® Standards and confirms if services were rendered within the 21 to 56 days after the delivery. If one of the CPT® codes listed above is billed on the date of delivery but the visit did not take place in the timeline of 21 to 56 days after delivery, MedStar Family Choice will retract a portion of the payment and the provider will be paid for the delivery only. The retraction amount is the difference between the reimbursement for a delivery code including postpartum and a delivery only CPT® code.
The only time a provider should bill for a postpartum only is when the postpartum visit is performed by a provider who is different than the provider who performed the delivery. This visit should be billed with CPT® code 59430.
If your office requires any clarification regarding billing modifiers in the global period, postpartum visits or any other questions about MedStar Family Choice’s global claims logic, please contact your Provider Relations Representative at 1-855-210-6203 or fax to 1-202-243-5497.