Introduction: What CPT 59510 Covers and Why It Matters

Positioning CPT 59510 Among Other OB Codes

Components of the Global Cesarean Package

Antepartum Care (Prenatal)

Typically 13 visits (one per 4 wks until 28 wks, biweekly until 36, weekly until delivery).

Initial history & physical, routine labs, ultrasounds, screening/counseling.

Complication management related to pregnancy.

Delivery (Intrapartum)

Surgical birth via low transverse or other approach.

Includes:

Incision (skin & uterus),

Delivery of fetus(es) & placenta,

Hemostasis, uterine & fascial closure,

Routine counts & wound dressing.

Postpartum Care

Hospital rounds, wound checks, 6-week office visit.

Breastfeeding counseling, mood screening, contraception.

Routine healing of incision.

When to Bill CPT 59510 (Decision Flow)

Documentation Requirements

Antepartum Records

Pregnancy confirmation & dating.

Full H&P.

All routine visits: vitals, fetal growth, counseling.

Labs, imaging, procedures (record even if separately billed).

Complications managed (gestational diabetes, PIH).

Operative Note (Cesarean)

Postpartum Notes

Hospital progress notes.

Wound checks, vitals, lochia.

Breastfeeding status.

Contraception & return-to-activity counseling.

Final 6-week visit.

 Services Included vs. Billable Separately

Split Care & Transfers

Handling Complications

Within global: PIH, gestational DM, mild anemia.

May justify -22: Massive hemorrhage, difficult extraction, extensive adhesiolysis, uterine rupture repair.

Outside global (bill separately): Appendectomy at cesarean, sterilization (58611), unrelated surgery.

 Building the Claim

Complex Scenarios

Multiple Gestations

Global usually covers one fee for all infants.

Some payers allow small add-on for second twin.

Sterilization at Cesarean

Bill 58611 with modifier (-51 or payer-specific).

Need separate consent per federal rules.

Failed TOLAC

If planned VBAC becomes cesarean, bill 59510 if you did ante + post.

Using Modifier -22

Apply when intraoperative work is far above typical:

Dense adhesions (e.g., prior surgeries).

Uterine rupture repair.

Cesarean hysterectomy (but that’s usually 59525 instead).

Very large fetus or malpresentation requiring extra effort.

Provide clear narrative + time metrics.

Quality & Risk Metrics

Cesarean rate vs VBAC.

EBL >1000 mL.

SSI rate.

Postpartum depression screening.

 Common Errors & Solutions

Internal Audit Checklist

Antepartum visits logged & signed.

Op note meets template.

Postpartum visit completed.

Dx codes match pregnancy outcome.

No double billing with labs or sterilization.

 Operational Tips

Front desk: flag patients who may transfer or switch to VBAC.

Coders: confirm service span vs date.

Providers: finalize op note same day.

Billers: submit within 5 days of discharge for faster payment.

Key Performance Indicators

Denial rate by reason.

Avg days from delivery to claim.

Net collection %.

-22 acceptance rate.

What does CPT 59510 pay for?

Routine prenatal visits, the cesarean birth, and postpartum care (up to 6 wks). It is a global code.

How is 59510 different from 59514 and 59515?

Are lab tests included?

No. Labs and ultrasounds are separate unless payer policy bundles them.

Can I bill E/M for a postpartum problem?

Yes, with modifier -24 if unrelated (e.g., mastitis, depression).

How to bill if another doctor does postpartum?

Use 59514 (cesarean only); postpartum provider bills 59430.

How do I document for 59510?

Complete prenatal chart

Operative report (indication, steps, EBL, outcome)

Signed postpartum note(s).

 What about cesarean with bilateral tubal ligation?

Bill 59510 + 58611 (sterilization). Include sterilization consent.

Does 59510 include treating gestational diabetes?

Routine management = included. If it escalates to complex endocrinology (e.g., insulin titration clinic), some payers allow additional E/M.

 How to handle twins?

Most payers: one fee for both. If allowed, append modifier for extra baby.

�� What’s the best way to avoid denials?

Verify you rendered all three components.

Keep detailed op note & prenatal log.

Use transfer-of-care notes for shared patients.