Revenue Cycle Insider

Should you wait to code prenatal visits until December 31?

The AMA has announced massive upcoming changes to the CPT^® code set that involves maternity services. These changes have left ob-gyn coders with lots of questions on how to report pregnancy services — with one question in particular standing out.

Continue reading to understand how the 2027 CPT^® maternity code changes will affect your coding for pregnancies spanning into the new year.

Enjoy a Quick Review of the Upcoming Changes

Let’s briefly look back on the what, when, and why of the 2027 CPT^® maternity services code changes:

• What: The AMA is instituting a component-based reporting model for maternity services. Providers will now be required to document and explicitly report each stage of maternity care as individual, independent functional services.
• When: The code changes take effect January 1.
• Why: Maternity care has evolved dramatically during the 30-plus years that the current CPT^® code structure has been in existence. The existing maternity codes fail to recognize the new patterns of care and greater patient complexity that exist in today’s clinical environment.

As ob-gyn coders prepare for the upcoming year, Revenue Cycle Insider explored two questions that coders keep asking. Read on for more information on these important end-of-year coding questions.

How Do You Report Pregnancies That Span From 2026 Into 2027?

One of the most significant questions that arises with the CPT^® changes to the maternity care services codes in 2027 is how to report services provided in both 2026 and 2027. The current global delivery codes will expire before the patient’s care is completed, and babies arrive when they want to — they don’t abide by the AMA’s coding rules.

From a CPT^® reporting perspective, you’ll report 2026 antepartum visit services using one of the following codes depending on the number of visits in 2026:

• 59425 (Antepartum care only; 4-6 visits)
• 59426 (… 7 or more visits)
• Evaluation and management (E/M) codes for one to three visits

Once the calendar flips to 2027, you’ll report E/M codes for antepartum visits provided. This follows the 2027 CPT^® guidelines for maternity care services instructing that you must report all antepartum visits exclusively with E/M codes, as the global delivery codes will no longer apply.

Check out the AMA’s Antepartum Transition Reporting Q&A to assist with your code assignment.

When Should You Begin to Report Transition Timing?

The ability to select between 59425 and 59426 will depend on the exact number of antepartum encounters completed in 2026. While this will not be known with certainty until closer to the end of the calendar year, you may consider planning ahead and identifying patients whose reporting may be impacted by the crossover based on their anticipated delivery dates.

Examine These Scenarios

Put what you’ve learned into practice by evaluating the following examples to see how you should code them:

Example 1: A patient’s first 10-week prenatal visit fell on May 9, 2026. This means the patient’s last menstrual period would have been around Feb. 28, 2026, and the estimated due date is Dec. 5, 2026.

In this case, you’ll use the current 2026 ob-gyn global code, including antepartum-only codes, such as 59425-59426. The delivery services will be included in 2026 codes such as the following:

• 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 (… including postpartum care)
• 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care)
• 59514 (Cesarean delivery only)
• 59515 (… including postpartum care)
• 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))
• 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)

Example 2: The patient’s first 10-week prenatal visit fell on Aug. 12, 2026. The patient’s last menstrual period would be around June 3, 2026, and the estimated due date would be March 10, 2027. This means that the patient will have roughly four to six prenatal visits in 2026 and six to eight prenatal visits in 2027.

For this scenario, the patient will have 10 to 14 prenatal visits from the start of the pregnancy to delivery. Report 59425 for the four to six visits occurring between August and December 2026 since they take place exclusively in 2026. You’ll then report an E/M code, such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient …), for each antepartum visit from January to March 2027 — or when the patient begins labor if the baby arrives after the estimated due date.

Lastly, you’ll report delivery separately with the 2027 delivery-only CPT^® codes, such as the following:

• 59431 (Vaginal delivery, with or without episiotomy)
• 59432 (… after previous cesarean delivery)
• 59502 (Cesarean delivery; primary)
• 59503 (… repeat)

You’ll also need to report any applicable codes for placenta delivery, episiotomy repairs, postpartum care, or hysterectomy procedures, if provided.

Stay tuned to Revenue Cycle Insider as we continue to examine the upcoming 2027 CPT^® Maternity Care Services code and guideline changes.

Aniket Sanjay Bagate, CPC, CEMC, Pune, Maharashtra, India