What does the medical code 59400 not include: a) delivery, b) a cerclage, c) antepartum (prenatal) care, or d) postpartum (after delivery) care?

CPT Code 59400 Does Not Include Cerclage

CPT code 59400 does not include cerclage procedures, as these are considered separate surgical interventions outside the global obstetrical package. 1

Components of CPT Code 59400

The comprehensive maternity care bundle represented by CPT code 59400 includes three main components:

1. Antepartum Care:

   • Monthly visits up to 28 weeks gestation
   • Biweekly visits from 29-36 weeks
   • Weekly visits from 37 weeks until delivery
   • Routine prenatal laboratory tests
   • Recording of weight, blood pressures, and fetal heart tones

2. Delivery:

   • Admission to the hospital
   • Management of uncomplicated labor
   • Vaginal delivery (with or without episiotomy, forceps, or vacuum)
   • Immediate postpartum care

3. Postpartum Care:

   • Hospital and office visits following vaginal delivery
   • Routine care through 6-8 weeks after delivery
   • Assessment of physical recovery
   • Contraceptive counseling
   • Breastfeeding support
   • Screening for postpartum depression

What Is Not Included in CPT 59400

• Cerclage procedures - These are specialized surgical interventions performed to prevent preterm birth by reinforcing the cervix 2
• Ultrasounds and non-stress tests
• Other specialized testing
• Services typically provided by other specialists
• Cesarean deliveries (which use different codes such as 59510 and 59618)

Understanding Cerclage as a Separate Procedure

Cerclage is a distinct surgical procedure that involves positioning a suture around the cervix to provide mechanical support and reduce the risk of preterm birth 2. There are different types of cerclage procedures:

• Transvaginal cerclage - The most common approach
• Transabdominal cerclage - Used in selected cases with recurrent mid-trimester pregnancy loss 3
• Robotic-assisted laparoscopic abdominal cerclage - A minimally invasive alternative 4

These procedures are coded separately from the global maternity package because they:

1. Are not routine parts of prenatal care
2. Require specific surgical expertise
3. Are only performed in high-risk cases with specific indications
4. May be performed during or outside of pregnancy

Clinical Context

Cerclage is typically reserved for women at high risk of preterm birth, such as those with:

• History of cervical insufficiency
• Short cervix identified on ultrasound
• Physical examination findings suggesting cervical insufficiency

The effectiveness of cerclage has been demonstrated in reducing the risk of preterm birth in high-risk women 2, but it represents a specialized intervention beyond standard maternity care.

Billing Implications

Understanding what's included in the global maternity package (59400) is essential for proper coding and billing. Cerclage procedures should be billed separately with their appropriate CPT codes to ensure proper reimbursement for these specialized services.