This guide addresses CPT® coding for maternity care services. It covers coding for professional services performed by physicians and other qualified health care professionals including Certified Nurse Midwives in obstetrics, family medicine, and maternal-fetal medicine.

It describes how to code for global maternity care, antepartum care only, delivery services only, postpartum care only, and itemized services when care is split between providers or payers. It describes what is bundled (not separately reported) and what is excluded – (potentially separately reported).

If all pregnant women entered the practice at 8 weeks, received all their prenatal and postpartum visits and delivery from the same practice, coding would be easy. However, patients move, change insurance, and sometimes deliver unexpectedly away from home.  And there are typical services that can be billed in addition to the maternity care package.

Table of Contents

• General Overview: Maternity Care Coding
• Coding Maternity Care and Delivery
• Included in the global package
• Separately Reportable Services
• High Risk Maternity Care or Complications of Pregnancy
• Antepartum care
• Delivery only Services
• Postpartum care
• Professional Services Coding for Maternity Admissions and Delivery
• Maternity Care Scenarios

Diagnosis Coding for Antepartum Care

Question:

Patient seen for antepartum care but delivered at 38 weeks at a different hospital/physician group. What diagnosis codes should we use for the visits before the birth episode.

Answer:

The diagnosis coding for antepartum care would be specific to the patient’s condition at the time care was provided.

If at the time of the visit the patient was having a routine pregnancy with no complications, you would choose an ICD-10-CM code from the category Z34, Encounter for supervision of normal pregnancy, as the first-listed code. If the patient has any condition complicating the pregnancy, a code from Chapter 15, Pregnancy, Childbirth, and the Puerperium, would be selected as the first-listed diagnosis.

Per the ICD-10-CM guidelines, Sec.I.C.15.b.3.,

In episodes when no delivery occurs, the principal diagnosis should correspond to the principal complication of the pregnancy which necessitated the encounter. Should more than one complication exist, all of which are treated or monitored, any of the complication codes may be sequenced first.

Unless, of course, it was that routine prenatal visit with no complications. Remember, these Z34 codes should not be used in conjunction with chapter 15 codes.

The American College of Obstetrics and Gynecology (ACOG) has two different guides that you might find helpful for more specific coding guidance in a particular case. Here are the links:

• 2024 OB/GYN Coding Manual: Components of Correct Coding
• ACOG OB/GYN Diagnostic Coding Quick Reference Guide

Other Sources:

• BlueCrossBlueShield of Alabama: Obstetrics Coding and Documentation Reference Guide 2020

Find more diagnosis coding resources here.