Global days for Maternity codes?

This week I was asked a question in regard to global days and maternity codes...  I always feel that if one person has this question, there may be others out there that are thinking the same way....    Enjoy... 

Q:  My physician is adamant that the global time for maternity care is 90 days...  but I was always under the impression it was only for 6 weeks?  Who is right??? 

A:  Technically - you both are correct.   CMS and CPT  global codes are designated as -0-. 10, or 90 day global care timeframes, however with maternity codes the 2011 National Physician Fee Schedule database designates those codes as MMM which means they are not subject to the -0-, 10, 90 day rules.  The MMM designation simply means that this is a maternity code, and the usual global concept does not apply.  However, the global concept of Antepartum, Delivery and postpartum care are all inclusive - to be billed as a package. 

Practice Standard for maternity care is broken down below: 

Antepartum care = aprox 13 office or outpatient care visits, up to admission to the hospital for delivery

Intrapartum/Delivery Care:  Care of the patient during the labor process, delivery of the infant, and post delivery care prior to hospital discharge (uncomplicated such as vaginal, cesarean section, v-back)

Postpartum Care:  Care of the uncomplicated delivery patient in the office/outpatient setting  from the time of hospital discharge up to 90 days post delivery. 

So, to sum up the answer - most vaginal delivery patients will only need care up to 6 weeks (45 days) however some patients may need post-partum care up to 12 weeks (90 days) for cesarean section.  So technically both of you are correct.  

The only way to definitively answer, is to check with your contracted insurance carriers and ask regarding timeframes for maternity care benefits.  Most of the Medicare/Medicaid carriers will adjudicate the maternity care to the 90 day limit, even though the Database states MMM. 

as always...... Feel free to e-mail me if you have questions...  HAPPY CODING!!! 

Tips to overcome maternity coding challenges for the inpatient coder

Tips to overcome maternity coding challenges for the inpatient coder


Maternity coding can be a challenge for inpatient coders Understanding what is comprised in obstetric/maternity care is critical to your success in coding and billing those services in the inpatient arena. Obstetric/maternity care is broken down into 3 separate areas
• Antepartum care
• Delivery of the baby(ies)
• Postpartum care

CPT has developed maternity codes that encompass services in a total obstetrical/maternity package, and allows the outpatient coder to bill for the antepartum, the delivery, and postpartum care in 1 CPT code. However, for the inpatient coder, you do not have that “luxury”. ICD-9 does not package those services into a single code set package.

Confusion about the codes is one of the first challenges that a coder has to face as an inpatient coder.
Maternity/obstetric care codes need to be broken down and analyzed as to which codes are appropriate for the services being rendered. Below are the basics for you to know

 What procedures and/or services is the hospital providing today?
 Appropriate diagnosis allocation (to include 4th and 5th digits)
 Auditing the services to ensure correct documentation by the provider to support the procedures billed by your facility

As a coder, when in doubt, always refer to your ICD-9 procedure’s (volume 3) to clarify guidelines and conventions of coding. In Chapter 13 (Obstetrical Procedures) of your ICD-9 Volume 3 Codes 72-75 , will provide you with all the majority of theprocedure codes you will need to bill obstetric/maternity code. , but in addition, you will need to be able to audit the physician documentation to accurately code these claims for your facility.

Codes set 72 includes a forcepts, vaccum and or breech delivery
Codes set 73 includes inductions and assistance procedures during delivery
Codes set 74 includes cesarean sections and the removal of a fetus
Codes set 75 includes other obstetric operations

In addition to the obstetrcal code sets, you also need to be familiar with the codes set from Chapter 12 which include the codes between 65 – 71), It is uncommon, but there are occasions when the obstetric/maternity patient has services provided that fall into the chapter 12 codes.

The key to coding and billing of obstetric/maternity related services, requires good, clear, documentation by the provider or physician, and a good understanding by the coder of what takes place during the maternity stay, to accurately code and bill for those services. The listed services below are normally included in obstetric/maternal services provided by the facility . This is not an all-inclusive list, but gives you an idea of what is involved.

Antepartum Services can include:
o Ultrasound(s)(Obstetric) radiologic services related to obstetrics
o Cerclage
o Insertion of a cervical dilator
o Echocardiography
o External cephalic version
o Fetal biophysical profile
o Administration of Rh immune globulin
o Amniocentesis
o Fetal Non-stress Test (NST)
o Blood Typing/and Rh factors and lab/pathology services related to maternity care
o Fetal non-stress testing
o Management and/or observation care of a chronic, stable illness such as pre-eclampsia, premature labor, diabetes, epilepsy, lupus erythematous or hypertension, Premature rupture of membranes etc//

Delivery Services can include:
 Admission to the hospital.
 Supervision and/or management of active labor, to include induction services.
 Vaginal, and Cesarean delivery.
 Delivery of placenta.
 Episiotomy.
 Fetal Services and monitoring (such as fetal EKG)
 Delivery of the placenta
 Repair of uterus, cervix or vagina during delivery

Postpartum care can include
 Procedures for post-delivery complications, such as hematoma, or obstetric hemorrhage status post delivery, or retained placenta
 services for sterilization
 symptoms and complications related to the pregnancy post delivery (i.e. seizures, diabetes, asthsma etc)

In addition to knowing what procedures you need to code for your facility, you also need to have a very good understanding of the diagnosis application to those procedures for maternity/obstetric patients. Again, if you are unsure, always refer to the coding conventions provided at the beginning of your ICD-9 manuals.
Below is a listing of common ob/maternity "complication" diagnoses. This “quick list” gives you an idea of diagnoses and symptoms you may want to be on the look-out for that may place your patient in a “risk” diagnosis area. You should always be on the look-out for diagnoses that have the CC (co-morbidity/complication) designation for your DRG grouper weights. :

– Pre-existing diabetes
– Gestational diabetes mellitus (GDM)
– Pregnancy-induced hypertension or pre-eclampsia
– Fetal anomaly or abnormal presentation (older than or equal to 36 weeks)
– Multiples (i.e. twins)
– Placenta previa
– Hypertension
– HIV (or abnormal screen)
– Prior preterm delivery
– Prior preterm labor requiring admission (e.g., early cervical change)
– Intrauterine fetal demise
– Prior cervical or uterine surgery
– Fetal anatomic abnormality
– Abnormal fetal growth
– Preterm labor requiring admission
– Abnormal amniotic fluid
– Bleeding
– Anemia
– Recurrent urinary tract infections or stones
– Advanced maternal age (35 yrs or older at EDC)
– Young maternal age (less than 16 yrs at EDC)
– Past complicated pregnancy

In coding and sequencing the diagnoses the 5th digit plays an important part of “telling the story” on your claim. ICD-9 Codes 640-649 and 651-676 require a 5th digit, and the list below denotes the “specific” episode of care. This 5th digit allows a vital understanding of whether or not the patient is in the antepartum, delivery, or postpartum phase of care.

– 0 – Unspecified (Rarely appropriate)
– 1 – Delivered with/without mention of antepartum condition
– 2 – Delivered with mention of postpartum complication
• Verify with supervisor before using these fifth digits in the outpatient clinic: 0-1-2
– 3 – Antepartum condition or complication
– 4 – Postpartum condition or complication

With Ob/Maternity services, sometimes the unexpected happens. You need to know how to code and bill services for miscarriage, ectopic tubal pregnancy, or an ectopic abdominal pregnancy. In these cases, the coder needs to bill the surgical intervention for the miscarriage or ectopic pregnancy. These procedure codes can be found in chapter 12, yet sometimes they are found in Chapter 13..

As you can see below two of the listed codes below are found in chapter 12, yet there are some that are reported from chapter 13.

o 66.62 Salpingectomy with removal of tubal pregnancy
o 69.02 Dilation and curettage following delivery or abortion
o 74.3 Removal of extratubal ectopic pregnancy


Another “big challenge” of OB/maternity coding is multiple gestations. In these cases, coders need to bill for multiple procedures based upon how many times performed, to directly correspond with the amount of babies that are delivered. ( i.e. 2 vaginal deliveries for twins.. Twin A and Twin B) These procedures CAN be different if Twin A is delivered via vaginal with a 72.4 code forceps rotation, and Twin B is delivered with code 72.71 as a vacuum extraction with an episiotomy.,

Last but not least … most hospital coding systems have a DRG grouper that is automated, but you should always check and know how to assign DRG's by hand.

To sum up the entire process for successful coding of inpatient obstetric/maternity care
 Understand and Know what encompasses maternity care
 Apply the correct procedure codes to the documentation from the provider/physician
 Apply the correct diagnosis codes to the procedures (and account for CC’s in your diagnosis application/allocation)
 Make sure you have the correct amount of “units” (in the case of multiple gestations)
 Double check your DRG groups/grouper that the services are weighted correctly and are grouped In the correct DRG codeset.