# Childbirth aftercare/IP subsequent day codes



## sbrabham (Oct 17, 2018)

When coding a inpatient hospital subsequent day after mother has the baby, what code would you use? Z391, Z392 or both? please explain. I have several different opinions in my department.


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## hollyw42 (Nov 15, 2018)

I'm currently going back and forth between Z39.0 and Z39.2 myself. I have one payer that wants Z39.0 for hospital postpartum care and Z39.2 for office postpartum care so I'm trying to decide whether or not to do that across the board. I'm to the point where I try to find any postpartum complication code to use to get out of using either of these codes in the hospital.

I would hesitate to use Z39.1 unless the encounter note indicates anything about lactation.

What are the opinions in your department?


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## Cmama12 (Nov 15, 2018)

We are using Z39.0 in the hospital and Z39.2 for office.


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## tracylc10 (Nov 27, 2018)

Z39.0 Encounter for care and examination of mother immediately after delivery.
            (Care and observation in uncomplicated cases when the delivery occurs outside a healthcare facility).

I understand this as meaning the pt delivered her baby before she got to the hospital without medical staff and was checked upon arrival to the facility, a global delivery charge was not used.  In this case, I would not think that it would be a subsequent visit.  

If, for your question, a global delivery code has been used, then all subsequent visits after the delivery would be bundled in the global code.  You would not code routine postpartum visits during the delivery hospital stay separately.

If code 59430, postpartum care only, is being used, then you would use Z39.2.

I agree with Holly and would only use Z39.1 if they were checking for routine lactation follow up. We never use this code. I'm guessing it is used by the lactation specialist.


I hope this helps.


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## hollyw42 (Nov 27, 2018)

On a related note... How do you interpret the use of the 59430 CPT code? This is the second day I have been going in circles over this particular code and everyone seems to have a differing opinion of it.

For context:
Our medcaid payers are all fee for service payers. So we have to bill antepartum, delivery and postpartum care separate. I have changed my recommendation twice now and I'm on the verge of changing it for the third time. I can't think about it straight anymore. I am open to anyone's thoughts and opinions.

Per CPT: 'Postpartum care only services (59430) include office or other outpatient visits following vaginal or cesarean section delivery.'

You also have CPT: 'When reporting delivery only services (59409, 59514, 59612, 59620), report inpatient postdelivery management and discharge services using Evaluation and Management Services codes (99217-99239).'

I know at the end of the day this all may be stipulated by each individual payer but it would be nice to see what others think. No one here seems to agree with my thought process and I'm the only certified coder here...


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## tracylc10 (Nov 30, 2018)

Our office really doesn't use 59430.  I am guessing that this would be used in cases that the delivery was outside of the facility and only routine global postpartum care was done.  Also, with Medicaid, you wouldn't use a global code, so you would just bill out each visit with an inpatient E&M code.  At least that is my thought on all of this.  

Sorry, adding to this...
59430 code description says "Includes: Office/other outpatient visits following c/s or vag delivery.  
So, if it is an inpatient, you would not use this code.  I would think you would just use the inpatient E&M codes then.

It really is all confusing and to bill correctly for specific payers, it would be best to contact them.


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## hollyw42 (Dec 5, 2018)

tracylc10 said:


> Our office really doesn't use 59430.  I am guessing that this would be used in cases that the delivery was outside of the facility and only routine global postpartum care was done.  Also, with Medicaid, you wouldn't use a global code, so you would just bill out each visit with an inpatient E&M code.  At least that is my thought on all of this.
> 
> Sorry, adding to this...
> 59430 code description says "Includes: Office/other outpatient visits following c/s or vag delivery.
> ...



This is my thought too. Was just curious what others thought.


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