Ob-Gyn Coding Alert

Reader Question:


Question: For CPT codes 59410 (vaginal delivery only [with or without episiotomy, and/or forceps]; including postpartum care) and 59515 (cesarean delivery only; including postpartum care), are birth control counseling and prescribing and sterilization counseling included if the counseling occurs within the six-week postpartum period?

Gary Yochim, D.O.
Leitchfield, Ky.

Answer: Some commercial insurance companies might consider payment for preventative care services for counseling coded 99401-99404 (preventative medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]) and diagnosis codes V25.09 (encounter for contraceptive management; general counseling and advice; family planning advice). Others may consider these as bundled with the global service for ob care when performed during the follow-up period for delivery. Check with specific carriers for their expectations. Their rules may have been modified or updated within the past few years.

Note: Refer to Optimize Payup by Scheduling a Separate Visit for Postpartum Contraception Counseling on page 76 of the October 1999 Ob-Gyn Coding Alert for additional information on contraceptive counseling within the global ob period.