Choose Your Postpartum Care Code Wisely

Accurate billing is essential to ensure compliance and proper reimbursement when obstetric care is split between providers. One common scenario is when a provider delivers antepartum care but does not manage the delivery, and the patient later returns for postpartum follow-up.

In these cases, CPT codes must reflect only your practice's services. This guide clarifies how to handle billing when postpartum care is rendered after the patient delivers with another physician.

Question About Choosing Your Postpartum Care Code

OBGYN provided all antepartum care, but the patient delivered out of town with a different physician. The patient has now returned to our office for her postpartum visit. We already billed for antepartum care only. What CPT code should we use for the postpartum visit?

Answer

You should report CPT code 59430 - Postpartum care only (separate procedure). This code covers the routine six-week postpartum checkup when it is not included in a global obstetric package. Since your office did not manage the delivery and has already billed for antepartum care, code 59430 appropriately represents the postpartum portion of the split care.

BillingFreedom Coding Insight: Proper Use of CPT 59430 for Standalone Postpartum Visits

At BillingFreedom, we approach postpartum billing in split obstetric care scenarios, strictly adhering to CPT guidelines and payer policies. When a patient receives antepartum care from your practice but delivers elsewhere, we ensure that only the services rendered are billed appropriately.

In such cases, we confirm that antepartum care has already been billed separately using CPT 59425 or 59426 and then use CPT 59430 to report the standalone postpartum visit. We carefully verify that the timing and content of the visit align with standard postpartum care, such as recovery evaluation, breastfeeding support, and family planning discussions, and that documentation supports the visit as distinct from global maternity care.

Our billing process avoids using global OB codes like 59400 when your provider did not manage all phases of care. We maintain clear, audit-ready documentation to demonstrate that the delivery occurred with an outside provider and that postpartum services were rendered independently.

Additionally, we check payer-specific guidelines to ensure the postpartum visit falls within the allowable timeframe and is covered under the patient’s plan. This meticulous approach protects your practice from billing errors, denials, and compliance issues that reflect BillingFreedom’s commitment to accurate, clean claims even in lower-reimbursement scenarios like postpartum-only care.

For more details about our exceptional ob/gyn billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472.