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Billing Prenatal and Postpartum Care Visits

July 29, 2019

Appropriate prenatal and postpartum care is integral to a healthy pregnancy and birth. It’s important to document the services delivered to your patients through specific and timely billing. Here are some coding tips to help you receive credit for meeting the Prenatal and Postpartum Care (PPC) HEDIS® measure.

Timely Prenatal Care is based on a prenatal visit in the first trimester of pregnancy. The first prenatal care visit during pregnancy usually includes a physical exam, weight, height, blood pressure, and urinalysis. Depending on the stage of the pregnancy, the visit may also include blood and imaging tests as well as discussions about maternal health, fetal health, and the pregnancy.

  • 0500F

Initial prenatal care visit (report at first prenatal encounter with health care professional providing obstetric care); please include date of visit and date of last menstrual period (LMP) in a separate field

  • 0501F 

Prenatal flow sheet documented in medical record by first prenatal visit, including:

  • Minimum blood pressure
  • Weight
  • Urine protein
  • Uterine size
  • Fetal heart tones
  • Estimated date of delivery (EDD)
  • Date of visit
  • Date of LMP (separate field)

Please note: Positive pregnancy test diagnosis (Z32.01) or diagnosis of amenorrhea (N91.2) are not appropriate billing when components of a full prenatal visit have been completed. These codes do not meet the definition of a first prenatal visit.

Postpartum Care (the second component of the PPC measure) is defined by mothers receiving a pelvic exam or postpartum visit on or between 21 and 56 days after delivery. Either of the following codes indicate a postpartum visit:

  • 0503F

Postpartum care visit

  • G0101

Cervical or vaginal cancer screening; pelvic and clinical breast examination

Right Start Clinical Practice Guidelines

The Right Start clinical practice guidelines and prenatal referral form have been updated to reflect current American College of Obstetrics and Gynecology (ACOG) standards. To request a paper copy, call 1-877-878-8785, option 2 and leave your name, address, and the specific guideline you are requesting.

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