Maternity/Obstetrical Care Benefits - CAM 366HB
Description:
Maternity/obstetrical care is the care of a pregnant female before, during and after the delivery of a child.
Policy Statement:
Most contracts of this health plan provide benefits for maternity/obstetrical care. The purpose of this policy is to outline and describe payment benefits of service(s) for those conditions that represent non-complicated and complicated conditions related to pregnancy.
Maternity Benefits:
Maternity care benefits are reimbursable under the following conditions for covered members:
Global care, which includes:
-
Antepartum Care: Initial and subsequent history, physical examination, recording of weight, blood pressures, fetal heart tones, routine chemical analysis (U/A), finger stick tests during each visit. Typically, there are monthly visits up to 28 weeks gestation, bi-weekly visits up to 36 weeks gestation and then weekly visits until delivery. There are times, however, that additional visits may be needed. Additional visits directly related to the pregnancy (e.g., cramping, abdominal pain, urinary tract infection, breast tenderness, etc.) are considered to be part of the global care and, as such, are not reimbursed separately. If the patient is seen for a condition that is NOT related to her pregnancy (ex., sinusitis, broken bones, etc.) the office visit may be reimbursed separately.
-
Delivery: This includes admission to the hospital, including history and physical examination, management of an uncomplicated labor, vaginal (with or without episiotomy, with or without forceps) or cesarean section. Multiple births are not considered a complication in the absence of other extenuating circumstances (an example of a complication would be abrupto placenta, uterine rupture, failure to progress in labor with maternal or fetal distress).
-
Postpartum Care: Includes hospital and office visits following vaginal or cesarean section delivery.
Lab Work: An obstetrical lab panel is reimbursable outside of the global care benefits. This panel must include the following:
-
Hemogram, automated and manual differential WBC count OR hemogram and platelet count, automated and automated differential WBC count
-
Hepatitis B surface antigen (HbsAg)
-
Antibody, rubella
-
Syphilis test, qualitative (e.g., VDRL, RPR, ART)
-
Blood typing, ABO and blood typing Rh (D)
-
Multiple serum marker testing (human chorionic gonadotropin [hCG] with maternal serum alpha-fetoprotein [MSAFP], unconjugated estriol and dimeric inhibin A) is considered MEDICALLY NECESSARY for pregnant women who have been adequately counseled and who desire information on their risk of having a Down syndrome fetus.
-
Screening culture, presumptive, pathogenic organisms for Beta Strep
- An initial presumptive urine drug screening
Fetal Non-Stress Testing: This test is a diagnostic procedure that gives an indirect assessment of the status of the pregnancy by assessing the fetal heart rate, fetal movement and uterine contractibility. It is appropriate for use for any condition that may affect the fetal outcome, such as hypertension, history of premature labor, intrauterine growth retardation, pre-eclampsia, etc.
Ultrasounds: An obstetrical ultrasound is the visualization of the inner structures by recording the reflections of pulses of ultrasonic waves directed into the tissues. The use of an ultrasound is considered to be a medically necessary tool in pregnancies from 10 – 18 weeks gestation. More than three or repeat ultrasounds during the course of a pregnancy require medical justification. Such justifications would include, but are not limited to, the following:
-
Increased risk factors (e.g., personal or family history of congenital anomalies)
-
High-risk factors (e.g., maternal diabetes, alcohol/drug addition, malnutrition)
-
Elderly primigravida
-
Suspected abnormalities of pregnancy (e.g., hydatidiform mole, ectopic pregnancy, threatened/missed abortion, congenital malformation, placenta previa, abrupto placenta, vaginal bleeding)
-
Pre-/post-amniocentesis studies
-
Suspected abnormal presentation of fetus
-
Suspected multiple fetuses
-
Suspected fetal demise
-
Gynecologic or other pelvic masses
-
Significant fetal growth abnormality as indicated by a discrepancy of fetal size and estimated age
Amniocentesis: An obstetrical procedure in which a small amount of amniotic fluid is removed for laboratory analysis. It is usually performed between 16 and 20 weeks of gestation to aid in the diagnosis of fetal abnormalities. An amniocentesis is typically performed for conditions, such as:
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The patient is of an advanced age at time of conception (35 years or older).
-
Has a child or an immediate family history of a child with a neural tube defect.
-
Has a child with or has an immediate family history of multiple abnormalities.
-
Has a child with RH sensitization or a current fetus with indication of RH sensitization.
-
The patient has medical problems that complicate pregnancy and require induction to determine fetal maturity.
-
The patient has a child with or an immediate family history of chromosomal abnormalities, sex linked abnormalities or autosomal recessive abnormalities that can be diagnosed prenatally.
-
History of multiple spontaneous abortions (in this current marriage or in a previous mating of either spouse).
An infrequent indication for an amniocentesis is for fetal sex determination for pregnancies, which are at risk for X-linked heredity disorders. This would include such conditions as:
-
Severe hemophilia.
-
X-linked mental retardation.
-
X-linked hydrocephalus.
-
Duchenne muscular dystrophy.
Benefits are NOT provided for an amniocentesis performed purely for sex determination in the absence of documented risk factors.
Multiple Births: The delivery of multiple births is NOT considered a complication of pregnancy in the absence of other complications or risk factors. In the event that there is a complication of pregnancy or delivery, the provider should file the appropriate modifier to indicate such complications for consideration of additional reimbursement.
Stand By Physicians: A physician who is asked to "stand by" during certain medical/surgical procedures or situations where the physician is needed to examine, diagnose or treat a patient should a complication arise. Attendance at high-risk delivery is a covered service when the delivery results in a healthy infant and the following are met:
-
It is requested by the attending physician.
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There is documentation of fetal distress or reasonable anticipation of newborn distress as in the situation stated above.
-
The pediatrician is directly involved in providing services to the infant.
Tubal Ligation During or After Delivery: If a tubal ligation is performed after a vaginal delivery, the procedure will be reimbursed at 100 percent of the allowable amount for the procedure. If the tubal ligation is performed during a cesarean section birth, the procedure will be reimbursed at 50 percent of the allowable amount for the procedure.
Anesthesia by the Attending Obstetrician or Delivering Physician: If the attending delivering obstetrician/physician performs the insertion of the epidural anesthesia and maintains that anesthesia, he/she may be reimbursed 50 percent of the allowable amount for that procedure.
**PLEASE SEE SPECIFIC CONTRACTS FOR LIMITATIONS AND EXCLUSIONS RELATED TO MATERNITY/OBSTETRICAL BENEFITS**
Coding Section
| Codes | Number | Description |
| CPT | 0502F | SUBSEQUENT PRENATAL CARE VISIT (PRENATAL) (EXCLUDES: PATIENTS WHO ARE SEEN FOR A CONDITION UNRELATED TO PREGNANCY OR PRENATAL CARE (E.G., AN UPPER RESPIRATORY INFECTION; PATIENTS SEEN FOR CONSULTATION ONLY, NOT FOR CONTINUING CARE)) |
| 0503F | POSTPARTUM CARE VISIT (PRENATAL) |
|
| 00842 | ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; AMNIOCENTESIS |
|
| 01958 | ANESTHESIA FOR EXTERNAL CEPHALIC VERSION PROCEDURE |
|
| 01960 | ANESTHESIA FOR VAGINAL DELIVERY ONLY |
|
| 01961 | ANESTHESIA FOR CESAREAN DELIVERY ONLY |
|
| 01962 | ANESTHESIA FOR URGENT HYSTERECTOMY FOLLOWING DELIVERY |
|
| 01963 | ANESTHESIA FOR CESAREAN HYSTERECTOMY WITHOUT ANY LABOR ANALGESIA/ANESTHESIA CARE |
|
| 01967 | NEURAXIAL LABOR ANALGESIA/ANESTHESIA FOR PLANNED VAGINAL DELIVERY (THIS INCLUDES ANY REPEAT SUBARACHNOID NEEDLE PLACEMENT AND DRUG INJECTION AND/OR ANY NECESSARY REPLACEMENT OF AN EPIDURAL CATHETER DURING LABOR) |
|
| 01968 | ANESTHESIA FOR CESAREAN DELIVERY FOLLOWING NEURAXIAL LABOR ANALGESIA/ANESTHESIA (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE PERFORMED) |
|
| 01969 | ANESTHESIA FOR CESAREAN HYSTERECTOMY FOLLOWING NEURAXIAL LABOR ANALGESIA/ANESTHESIA (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE PERFORMED) |
|
| 57022 | INCISION AND DRAINAGE OF VAGINAL HEMATOMA; OBSTETRICAL/POSTPARTUM |
|
| 58605 | LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, POSTPARTUM, UNILATERAL OR BILATERAL, DURING SAME HOSPITALIZATION (SEPARATE PROCEDURE) |
|
| 58611 | LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S) WHEN DONE AT THE TIME OF CESAREAN DELIVERY OR INTRA-ABDOMINAL SURGERY (NOT A SEPARATE PROCEDURE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
| 59000 | AMNIOCENTESIS; DIAGNOSTIC |
|
| 59001 | AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID REDUCTION (INCLUDES ULTRASOUND GUIDANCE) |
|
| 59020 | FETAL NON-STRESS TEST | |
| 59025 |
FETAL CONTRACTION STRESS TEST |
|
| 59160 | CURETTAGE, POSTPARTUM |
|
| 59200 | INSERTION OF CERVICAL DILATOR (E.G., LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE) |
|
| 59300 | EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING |
|
| 59320 | CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL |
|
| 59325 | CERCLAGE OF CERVIX, DURING PREGNANCY; ABDOMINAL |
|
| 59350 | HYSTERORRHAPHY OF RUPTURED UTERUS |
|
| 59400 | ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS) AND POSTPARTUM CARE |
|
| 59409 | VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); |
|
| 59410 | VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); INCLUDING POSTPARTUM CARE |
|
| 59414 | DELIVERY OF PLACENTA (SEPARATE PROCEDURE) |
|
| 59425 | ANTEPARTUM CARE ONLY; 4 – 6 VISITS |
|
| 59426 | ANTEPARTUM CARE ONLY; 7 OR MORE VISITS |
|
| 59430 | POSTPARTUM CARE ONLY (SEPARATE PROCEDURE) |
|
| 59510 | ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY AND POSTPARTUM CARE |
|
| 59514 | CESAREAN DELIVERY ONLY; |
|
| 59515 | CESAREAN DELIVERY ONLY; INCLUDING POSTPARTUM CARE |
|
| 59525 | SUBTOTAL OR TOTAL HYSTERECTOMY AFTER CESAREAN DELIVERY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
| 59610 | ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS) AND POSTPARTUM CARE, AFTER PREVIOUS CESAREAN DELIVERY |
|
| 59612 | VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); |
|
| 59614 | VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); INCLUDING POSTPARTUM CARE |
|
| 59618 | ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY AND POSTPARTUM CARE, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS CESAREAN DELIVERY |
|
| 59620 | CESAREAN DELIVERY ONLY, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS CESAREAN DELIVERY; |
|
| 59622 | CESAREAN DELIVERY ONLY, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS CESAREAN DELIVERY; INCLUDING POSTPARTUM CARE |
|
| 59871 | REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHER THAN LOCAL) |
|
| 76801 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, FIRST TRIMESTER (< 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION, |
|
| 76802 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, FIRST TRIMESTER (< 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
| 76805 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, AFTER FIRST TRIMESTER (> OR = 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION |
|
| 76810 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, AFTER FIRST TRIMESTER (> OR = 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
| 76811 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION PLUS DETAILED FETAL ANATOMIC EXAMINATION, TRANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION |
|
| 76812 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION PLUS DETAILED FETAL ANATOMIC EXAMINATION, TRANSABDOMINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
| 76813 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR TRANSVAGINAL APPROACH; SINGLE OR FIRST GESTATION |
|
| 76814 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR TRANSVAGINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
| 76815 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, LIMITED (E.G., FETAL HEART BEAT, PLACENTAL LOCATION, FETAL POSITION AND/OR QUALITATIVE AMNIOTIC FLUID VOLUME), 1 OR MORE FETUSES |
|
| 76816 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (E.G., RE-EVALUATION OF FETAL SIZE BY MEASURING STANDARD GROWTH PARAMETERS AND AMNIOTIC FLUID VOLUME, RE-EVALUATION OF ORGAN SYSTEM(S) SUSPECTED OR CONFIRMED TO BE ABNORMAL ON A PREVIOUS SCAN), TRANSABDOMINAL APPROACH, PER FETUS |
|
| 76817 | ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, TRANSVAGINAL |
|
| 76818 | FETAL BIOPHYSICAL PROFILE; WITH NON-STRESS TESTING |
|
| 76819 | FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING |
|
| 76820 | DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY |
|
| 76821 | DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY |
|
| 76825 | ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING; |
|
| 76826 | ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR REPEAT STUDY |
|
| 76827 | DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; COMPLETE |
|
| 76828 | DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; FOLLOW-UP OR REPEAT STUDY |
|
| 76946 | ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION |
|
| 80055 | OBSTETRIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: BLOOD COUNT, COMPLETE (CBC), AUTOMATED AND AUTOMATED DIFFERENTIAL WBC COUNT (85025 OR 85027 AND 85004) OR BLOOD COUNT, COMPLETE (CBC), AUTOMATED (85027) AND APPROPRIATE MANUAL DIFFERENTIAL WBC COUNT (85007 OR 85009) HEPATITIS B SURFACE ANTIGEN (HBSAG) (87340) ANTIBODY, RUBELLA (86762) SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (E.G., VDRL, RPR, ART) (86592) ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE (86850) BLOOD TYPING, ABO (86900) AND BLOOD TYPING, RH (D) (86901) |
|
| 82105 | ALPHA-FETOPROTEIN (AFP); SERUM | |
| 82106 | ALPHA-FETOPROTEIN (AFP); AMNIOTIC FLUID |
|
| 83662 | FETAL LUNG MATURITY ASSESSMENT; FOAM STABILITY TEST |
|
| 85004 | BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT |
|
| 85007 | BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBCCOUNT | |
| 85009 | BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT, BUFFY COAT |
|
| 85014 | BLOOD COUNT; HEMATOCRIT (HCT) |
|
| 85018 | BLOOD COUNT; HEMOGLOBIN (HGB) |
|
| 85025 | BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERENTIAL WBC COUNT |
|
| 85027 | BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) |
|
| 85032 | BLOOD COUNT; MANUAL CELL COUNT (ERYTHROCYTE, LEUKOCYTE OR PLATELET) EACH | |
| 85048 | BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED |
|
| 85049 | BLOOD COUNT; PLATELET, AUTOMATED | |
| 86592 | SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (E.G., VDRL, RPR, ART) |
|
| 86762 | ANTIBODY; RUBELLA |
|
| 86900 | BLOOD TYPING; ABO |
|
| 86901 | BLOOD TYPING; RH (D) |
|
| 87077 | CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE |
|
| 87081 | CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY; |
|
| 87340 | INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE-STEP METHOD; HEPATITIS B SURFACE ANTIGEN (HBSAG) |
|
| 87653 | INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TECHNIQUE |
|
| 87802 | INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GROUP B |
|
| 99360 | STANDBY SERVICE, REQUIRING PROLONGED ATTENDANCE, EACH 30 MINUTES (E.G., OPERATIVE STANDBY, STANDBY FOR FROZEN SECTION, FOR CESAREAN/HIGH-RISK DELIVERY, FOR MONITORING EEG) |
|
| 99500 | HOME VISIT FOR PRENATAL MONITORING AND ASSESSMENT TO INCLUDE FETAL HEART RATE, NON-STRESS TEST, UTERINE MONITORING AND GESTATIONAL DIABETES MONITORING |
|
| HCPC | G0431 | DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES BY HIGH COMPLEXITY TEST METHOD (E.G., IMMUNOASSAY, ENZYME ASSAY), PER PATIENT ENCOUNTER |
| G0434 | DRUG SCREEN, OTHER THAN CHROMATOGRAPHIC; ANY NUMBER OF DRUG CLASSES, BY CLIA WAIVED TEST OR MODERATE COMPLEXITY TEST, PER PATIENT ENCOUNTER |
|
| G0477 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service. |
|
| G0478 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service. |
|
| G0479 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service. |
|
| H1001 | PRENATAL CARE, AT-RISK ENHANCED SERVICE; ANTEPARTUM MANAGEMENT |
|
| S3625 | MATERNAL SERUM TRIPLE MARKER SCREEN INCLUDING ALPHA-FETOPROTEIN (AFP), ESTRIOL AND HUMAN CHORIONIC GONADOTROPIN (HCG) |
|
| S3626 | MATERNAL SERUM QUADRUPLE MARKER SCREEN INCLUDING ALPHA-FETOPROTEIN (AFP), ESTRIOL, HUMAN CHORIONIC GONADOTROPIN (HCG) AND INHIBIN A |
|
| S9212 | HOME MANAGEMENT OF POSTPARTUM HYPERTENSION, INCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE THIS CODE WITH ANY HOME INFUSION PER DIEM CODE) |
|
| S9438 | CESAREAN BIRTH CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION |
|
| S9439 | VBAC (VAGINAL BIRTH AFTER CESAREAN) CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION | |
| S9442 | BIRTHING CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION |
|
| ICD-9 Diagnosis | 181 | MALIGNANT NEOPLASM OF PLACENTA |
| 2361 | NEOPLASM OF UNCERTAIN BEHAVIOR OF PLACENTA |
|
| 62981 | RECURRENT PREGNANCY LOSS WITHOUT CURRENT PREGNANCY |
|
| 630-67914 | COMPLICATION OF PREGNANCY CHILDBIRTH AND PUERPERIUM |
|
| 7600-7639 | MATERNAL CAUSES OF PERINATAL MORBIDITY AND MORTALITY |
|
| 7640-7799 | OTHER CONDITIONS ORIGINATION IN THE PERINATAL PERIOD. ***Please note that some of these diagnoses, although associated with the perinatal period, are generally used for the newborn and not the mother. |
|
| 7923 | NONSPECIFIC ABNORMAL FINDINGS IN AMNIOTIC FLUID |
|
| 7965 | ABNORMAL FINDING ON ANTENATAL SCREENING |
|
| V220 - V242 | PREGNANCY, HIGH-RISK PREGNANCY, POSTPARTUM CARE AND EXAM |
|
| V270-V279 | OUTCOME OF DELIVERY |
|
| V280-V289 | ENCOUNTER FOR ANTENATAL SCREENING OF MOTHER |
|
| V3000-V3921 | LIVEBORN INFANTS ACCORDING TO TYPE OF BIRTH |
|
| V616 | ILLEGITIMACY OR ILLEGITIMATE PREGNANCY |
|
| V617 | OTHER UNWANTED PREGNANCY |
|
| V7240-V7242 | PREGNANCY EXAMINATION OR TEST |
|
| V890-V8909 | OTHER SUSPECTED CONDITIONS NOT FOUND |
|
| V9100-V9199 | MULTIPLE GESTATION PLACENTA STATUS |
|
| ICD-10-CM (effective 10/01/15) | C58 | Malignant neoplasm of placenta |
| D392 | Neoplasm of uncertain behavior of placenta |
|
| N96 | Recurrent pregnancy loss |
|
| O00-O9A | Pregnancy, childbirth and the Puerperium |
|
| P00-P96 | Certain Conditions Originating in the Perinatal Period | |
| Z3400 | Encounter for supervision of normal first pregnancy, unspecified trimester |
|
| Z3480 | Encounter for supervision of normal first pregnancy, unspecified trimester |
|
| Z3490 | Encounter for supervision of normal pregnancy, unspecified, unspecified trimester |
|
| Z331 | Pregnant state, incidental |
|
| Z390 | Encounter for care and examination of mother immediately after delivery |
|
| Z391 | Encounter for care and examination of lactating mother |
|
| Z392 | Encounter for routine postpartum follow-up |
|
| Z37-Z379 | Outcome of Delivery |
|
| Z36 | Encounter for antenatal screening of mother |
|
| Z38-Z388 | Liveborn infants according to place of birth and type of birth |
|
| Z640 | Problems related to unwanted pregnancy |
|
| Z3200 | Encounter for pregnancy test, result unknown |
|
| Z3202 | Encounter for pregnancy test, result negative |
|
| Z3201 | Encounter for pregnancy test, result positive |
|
| Z0371 | Encounter for suspected problem with amniotic cavity and membrane ruled out |
|
| Z0372 | Encounter for suspected placental problem ruled out |
|
| Z0373 | Encounter for suspected fetal anomaly ruled out | |
| Z0374 | Encounter for suspected problem with fetal growth ruled out | |
| Z0375 | Encounter for suspected cervical shortening ruled out |
|
| Z0379 | Encounter for other suspected maternal and fetal conditions ruled out |
|
| O30009-O030099 | Twin Gestation |
|
|
O030109-O030199
|
Triplet Gestation |
|
| O30209-O03299 | Quadruplet Gestation |
|
| O30809-O30899 | Other specified multiple Gestation |
Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.
This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.
"Current Procedural Terminology © American Medical Association. All Rights Reserved"
History From 2024 Forward
| 01/01/2024 New Policy | |