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Prenatal and Postpartum Service Codes

Date: 07/11/23

As a healthcare provider, you understand the importance of prenatal and postpartum care for your patients. Seeking this care early in the pregnancy and attending all the recommended visits can increase successful outcomes for both the parent and child(ren).

Prenatal care takes place before the delivery date and postpartum care takes place seven to 84 days after delivery.

Arkansas Total Care wants to make sure all members who are going through prenatal or postpartum journeys get the care they need, and that it is properly documented. To ensure a complete picture of all the services offered, you must indicate the first date of prenatal care and the first date of postpartum care when billing any of the bundled service codes below. Proper documentation will lead to timely billing and paying out of claims.

Bundled Services:

  • Full duration of pregnancy: 59400, 59510, 59610, 59618
  • Partial duration of pregnancy: 59410, 59425, 59426, 59515, 59614, 59622

For prenatal care, please indicate the date the visit(s) occurred and evidence of one of the following:

  • A diagnosis of pregnancy
  • A basic physical obstetrical examination
  • Evidence that a prenatal care procedure was performed
  • Documentation of LMP, EDD, or gestational age

For postpartum care, please indicate the date the visit(s) occurred and evidence of one of the following:

  • Pelvic exam
  • Evaluation of weight, blood pressure, breasts, and abdomen
  • Notation of postpartum care
  • Perineal or cesarean incision/wound check
  • Screenings for depression, anxiety, tobacco use, substance use disorder, or preexisting mental health disorders
  • Glucose screening for patients with gestational diabetes
  • Documentation of any of the following:
    • Infant care or breastfeeding
    • Resumption of intercourse
    • Birth spacing or family planning
    • Sleep/fatigue
    • Resumption of physical activity
    • Attainment of healthy weight

For more information about these and other quality measures, visit our Provider Resources page today.