EM Coding Alert

Question: I have a patient who didn’t deliver with us and came back for postpartum (PP) care. I see from some sources online this code should be billed 21 to 56 days PP. Does that time frame still apply regardless of whether they were seen sooner for a problem visit? Would I charge the office visit charge for the problem visit and wait until they came back for a routine PP visit to charge the 59430, so we don’t lose money? Or do we have to charge 59430 always for the first visit right after delivery regardless of that 21- to 56-day timeframe?

Nevada Subscriber

Answer: If the reason for the initial visit is significant complication of the pregnancy or delivery, then you can bill for this using an established patient evaluation and management (E/M) service. Code 59430 (Postpartum care only (separate procedure)) is meant to cover routine PP care, not complicated PP care. Just be sure the documentation supports the level of service billed. Minor problems that might be expected after delivery may not support billing separately in the eyes of the payer.