#192 The Postpartum Same-Day Trap

Deliver at 11 PM Tuesday and round at 1 AM Wednesday: paid. Deliver at 8 AM Tuesday and round at 4 PM Tuesday: included in the delivery code, and billing it separately is a compliance violation. Same clinical work, two different outcomes. The only variable is the calendar. Starting January 1, 2027 postpartum care moves to E/M billing with hospital rounds, discharge management, and outpatient checkups all individually billable. Dr. Heather Signorelli walks through the code sets, the same-day trap, the multi-provider wrinkle, and the three-step workflow that catches it every time. 

The end of the postpartum bundle: 

Code 59430 (postpartum care only) is deleted January 1, 2027. All postpartum care moves to E/M billing. Two settings, two code sets: inpatient (hospital rounds) and outpatient (office visits). 

Inpatient postpartum codes: 

Subsequent hospital care: 99231, 99232, 99233 for daily rounding visits after the date of delivery. Discharge day management: 99238 (30 minutes or less) or 99239 (over 30 minutes). Every rounding day after delivery, on a new calendar date, is a separately billable E/M encounter. Documentation has to support the level. A one-liner does not support a 99233. 

Outpatient postpartum codes (with telehealth correction): 

Standard office E/M: 99212 through 99215 with modifier TH. Telehealth uses the same 99212 through 99215 codes with modifier 95 or GT, and place of service 02 or 10. There is no separate “98000” telehealth code set, contrary to earlier references in this series. Modifier TH on all postpartum E/M codes communicates the maternity context to the payer. 

The same-day rule: 

Postpartum E/M codes CANNOT be reported on the same calendar date as the delivery code. Same-day postpartum management is included in the delivery code. Calendar date means midnight to midnight, not twenty-four hours from delivery time. 

The multi-provider wrinkle: 

If Dr. Smith delivers at 8 AM and Dr. Jones rounds at 4 PM the same day, Dr. Jones cannot bill an E/M for that visit. The delivery code covers same-day postpartum regardless of which provider from the same group performs it. This requires an internal compensation and attribution policy, not just a billing rule. 

The workflow fix — three steps: 

• Timestamp discipline on every delivery and rounding note 
• Billing team hard stop: verify delivery date before dropping any postpartum E/M charge 
• Daily L and D reconciliation: track delivery date, rounding date, and provider by patient, daily 

The revenue opportunity: 

Every hospital rounding day after the delivery date is a new billable E/M. Extended stays from complications (postpartum hemorrhage, severe preeclampsia, wound infection, NICU situations) all generate additional charges. Complexity matters for reimbursement. Outpatient two-week and six-week checks are now individually billable instead of absorbed into a global fee. The same-day rule is the risk. Everything after midnight is the opportunity. 

Quick Reference Table:
Topic                                                                             What to know

Deleted postpartum code                            59430 — deleted Jan 1, 2027 

Inpatient rounds                                             99231 – 99233 

Discharge codes                                                      99238 (≤30 min) · 99239 (>30 min)

Outpatient postpartum                                 99212 – 99215 + modifier TH 

Telehealth modifier                                        Modifier 95 or GT · POS 02 or 10 

                                                                            NOT a separate 98000     code set 

Same-day rule                                                           Postpartum E/M cannot be billed on the                                                                              same calendar date as the delivery 

Calendar definition                                        Midnight to midnight 

Multi-provider same-day                                    Delivery code covers regardless of                                                                                       which group provider rounds

Workflow fix                                                    Timestamps · billing hard stop · daily                                                                                    reconciliation

RESOURCES BLOCK 

• Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar 
• Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ 
• Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 
• Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist 
• RECOVER Diagnostic Quiz · natrevmd.com/quiz 
• Series Part 3 (EP191): https://podcasts.apple.com/us/podcast/191-labor-management-is-no-longer-invisible/id1624182351?i=1000775009191

Transcript

SPEAKER_00 0:05

The last couple of weeks we have been going over the OB changes that are coming in 2027. So we've talked prenatal, we've talked delivery codes and labor management. And so this week we're going to talk about the postpartum care and how that integrates into everything. Welcome to Nat RevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signarelli, founder of Nat RevMD. Let's get started. So I was grateful enough to have Amy and Maria on our team who are OB specialty coders who have been helping us prepare for this change in 2027. I do want to share that I do think that this is all doable. I'm hopeful that this provides more revenue for practices as long as you guys are documenting. And so if you guys haven't listened to those first few OB podcasts, please go check those out. This is part of a five-part series. So last week we said the work was always there, right? Now it's about getting paid. So you were always doing all of this work and you were getting paid as a lump sum, but that didn't always inherently reimburse you for complex patients. And so this week we're going to be talking about postpartum care, and that is going to be moving to billing similar to prenatal care. So hospital rounds become individually billable, outpatient checkups do as well. And so every day you round on the patient, every calendar day, with one exception, is basically new revenue for your practice. So the one exception is important to understand. And I think it may cause problems if you're not thinking about it and having a specific workflow around this in preparation for January. So today we're going to cover that postpartum care and how to build hospital rounds, how to handle those outpatient follow-ups, and how to just think about these same-day traps when it comes to the delivery and what's wrapped up into that delivery. So just a reminder, right? We all know that codes 59430, so that's that postpartum care only code, is going to be deleted, similar to multiple other codes that are deleted. And all of the other global partial global codes that we've already covered are all gone, right? So now all postpartum care is moving to EM Billing. So that's going to be the same framework as the antipartum care. Every encounter is going to have its own code, its own documentation, which we've talked about how important that is, its own claim. Now there are going to be two separate settings, right? There's the inpatient setting, which is your hospital rounds, and then the outpatient, which is going to be your office visits. And obviously, those are going to have different codes. Your inpatient hospital postpartum rounds are going to be those subsequent hospital care codes, the 99231, 32, 3.3. And you're going to use these for daily rounds after the date of delivery. And discharge J management is 99238 if the discharge time is 30 minutes or less, or 99239 if it's over 30 minutes. And you're going to use these on the day the patient goes home. Now, every rounding day after delivery on a new calendar date, and this is important, is a separate billable encounter. Under the global model, your daily rounds were bundled into the delivery fee. And now every day you round on that patient, with one exception, you are going to bill a separate charge. That is going to be, you know, revenue that you want to make sure that you're capturing to count for the global charge that you were getting previously. And key here, like we talked about before, is documentation standards are going to be important, right? So the hospital rounding note has to support the level that you build. And so the one-liner does not support a 99233. And so you really have to have a note reflecting the assessment, the data reviewed, management decisions, et cetera, so that you can qualify for the right level of care. And I think that this is where it's going to be really, really important. Because before you were getting, you know, $3,000, $2,500, whatever your global fee was. And that included all the prenatal visits, included the delivery and the postpartum care. And if you don't make sure that you're billing out the right level of complexity along the way and documenting for that, that's where you could potentially either not see a patient enough times or document enough complexity to hit that same global revenue that you were getting before. I'm optimistic that the way that the system is set up is that it will get close. But these are the sort of things you want to make sure that you document correctly and that your providers are used to that so that these things are hardwired now and not in January. So outpatient postpartum office visits are going to be the standard office codes, you know, your 99212 through the 99215s, again, with that modifier TH for the maternity-related care. So again, same framework as we talked about with Maria in the antipartum state. Telehealth postpartum visits, you're going to use those same 99212 through 99215 codes with the telehealth modifiers, again, like you have been doing and not uh so there's no separate code set for those. Now the eye codes obviously the same. It's just those modifiers that are changing. So the so the key here is that documentation has to support the E level. So this is where, you know, we chatted with both Maria and Amy in the last couple of episodes that the one-liners, the flow sheets, the things aren't going to be um uh, you know, simple one-liners that are gonna be key here. So you really have to tell the story, right? So incision healing will clear for activity is a 99212. But managing postpartum hypertension with medication adjustments, a wound infection, or, you know, positive depression screen with a management decision. Now that's where you're gonna get those higher level EM codes. And so really, really critical again to document all of the things that are going on in the visit. Again, we talked about the modifiers, TH on those postpartum ENM codes is gonna be able to communicate to the payer that these are in the maternity context and not, you know, not outside of that. And so, really, really important to make sure that that is done. As you guys know, we are doing a uh webinar on this topic next week, July 7th. So please head on over to the show links and register. If you aren't able to make it live, no big deal. The registration will um have a recording that we'll send out if you've if you have registered. And we're gonna really talk about documentation and just making sure you're set up for success um ahead of January's changes. All right, so I do want to cover the same day trap and make sure that you guys are thinking through how this is gonna impact billing. So basically, what the AMA rule around same-day postpartum care says is that postpartum codes cannot be reported on the same calendar date as the delivery code. So same day postpartum management is gonna be included in that delivery code. And so this is the rule for, you know, the new codes. So calendar date basically means midnight to midnight, not a 24-hour from delivery time. And so the calendar flips at midnight is what matters. So if you deliver it at 8 a.m. on Tuesday, same day coverage runs until 11.59 p.m. on Tuesday, right? That same day. So any rounding done on Tuesday is gonna be included in that delivery code. Now, obviously, you need to round when you need to round clinically, but say the flip side of that is you have a patient who delivers at 11 p.m. on Tuesday, and that delivery code covers through 11.59 on Tuesday. So then rounds the next day at 8 a.m. are gonna be a new calendar date and a separately billable um event. So just important to make sure that you understand that. Again, you know, your workflows and when you see patient oftentimes have to do with how the patient is doing. Are they discharging the next day, et cetera? And so again, this is more just important for you to understand how this uh may be billable and when you need to add that additional CPT code and an additional note in order for it to be a separate billable event. So obviously this rule is simple, but you do just want to make sure that you're not getting tripped up because the billing team, you know, you and the billing team are gonna have to coordinate how to drop those charges so that we're looking at timestamps and paying attention. And a good footnote on multi-providers, and this is where most practices may get uh tripped up. So if Dr. Smith does the delivery at 8 a.m., Dr. Jones covers the afternoon shift and rounds at 4 p.m., that 4 p.m. visit is still included in the different delivery code, even though it was a different provider performed it. Now, again, that's obviously within the same group. So Dr. Jones cannot bill an for that visit, even though they didn't do the delivery that morning because the delivery code again covers same day postpartum, regardless of the provider from the same group who performs it. So your practice just needs to have a clear internal policy to make sure who gets credit and compensation for those same day postpartum rounds that cannot generate a separate charge. So I know that some of your groups have uh call coverage and coverage for one another. So you'll just want to think through how you manage that and with regards to commission if you pay your group on commission. Again, this should be a minor thing, and at the end of the day, it probably all evens out amongst providers in a multi-group setting, but you just want to think through that on at least setting expectations, right? So obviously internal compensation conversation that you can have. And again, something that's important to bring up now, obviously not going into effect until January. All right, so let's talk about the workflow for this. So we're gonna talk about three steps that you can use and go from there. So, all right, first you want to really make sure that you have discipline around timestamps, right? So providers do have to timestamp delivery notes and rounding notes because that calendar date is going to become important. And so, you know, again, that midnight threshold then becomes critical. So every postpartum note on the same calendar date cannot be separately billed. But without timestamps, your billing team or even the office is not gonna know or remember what they can bill for. And so, really, really and critical to have timestamps. And most of your notes probably already do this, but you just want to double check. Now, the second thing is that you really want to make sure that with your billing team, there's a process to make sure that we're not, you know, accidentally billing that postpartum on the same day. And so before dropping any hospital for a postpartum patient, we're gonna have to have billing verify what is the date of delivery. And if the delivery date equals the rounding date, you're gonna obviously scrub that charge. So we'll wanna have either an automated rule built into the EHR if that's possible, or a manual review. Um, hopefully, as these rules get put into place, we'll have those edits and rules that we can add to the clearinghouse or to the practice management software. Now, the last thing is just daily L and D reconciliation. So the same day reconciliation process from the labor management episode is going to apply here, right? So you're gonna be tracking those delivery dates, those rounding dates, and those provider by patient daily so that you can catch any issues from a claim perspective ahead of time. Obviously, this is not something we want to wait until denials show up. You wanna be able to create this process so that you, you know, again, clearly have those time stamps and clearly aren't uh billing deliveries and uh those postpartum checkups on the same date. A lot of this information is exactly why we're talking about this now in July and not in January, because we want to make sure that you guys have time to set up the huddles, right? Like I think listening to these podcasts, share them with your OB friends, come to the webinar and then really get a game plan, which is what you guys are gonna walk away from in the webinar of okay, these are the numbers I need to pull today, these are the levels of communication that I need to have with my team. This is uh what you know, what we're gonna be building between July and the end of the year, just to make sure folks are aware of the changes and the workflows that are going to change. And that way when you start January, it is like easy peasy. I've we've talked to our team, we've got a plan, we're documenting appropriately, and now we're gonna be dropping those bills correctly. So, like I said, uh webinar registration link in the show notes, and it will be July 7th at 5 p.m. Eastern. So obviously we've talked about the same-day billing trap, but what I hope that this brings is revenue for you guys that you weren't able to capture before. And really, this is around complex patients who are in multiple days in a row or who have things that you're managing outside of the delivery that makes it easier to capture. So that's what our team is hopeful for. We're hopeful that this gets you guys the revenue you deserve for the complexity of patients that you're already managing. So, one key thing here that I really do think the model pays for, that the old one did not, is that every hospital rounding day after that delivery date is a new billable EM. And so under the global mode, global model, right, those days were included. And so if a patient was in for three, four days, they, you know, may, you know, you're managing those patients, but you're getting the same global fee as if that patient had, you know, been in for a day or two. And so obviously, this newer model does give you that capability of billing that separate charge for the days of visits that are extended. And so I do think that this is an option or an opportunity to capture that revenue because those extended stays from complications like a postpartum hemorrhage or a severe preeclampsia or wound infection or a nuke situation. So every additional day is an additional charge. And so the complexity of those postpartum encounters now matters. And that's what I'm hopeful for. So managing a patient with severe postpartum hypertension is no longer going to be the same as like a routine 24-hour stay. And outpatient postpartum visits, the two-week and six-week checkups are now individually billable EM encounters. So you are going to want to make sure, especially if clinically indicated, those are coming back. And again, you can do some of those telehealth, but that way it's just not being absorbed into the global fee, especially if you have uh postpartum complications that you're managing. So, just, you know, to sum this all up, postpartum billing aligns with the work that you're actually doing. So it's going to reward you for those complex patients that you're documenting, extended stays. Just be careful that same day rule. We just want to really make sure that you understand that rule, that you have a process in place to make sure that we're not uh double billing and getting that time-stamped information over to both your documentation as well as to your billing team. And last but not least, we will be doing two more of these episodes and being able to wrap this up with the webinar next week so that you guys are all prepared for a January one. As always, uh, hopefully you enjoyed this podcast. We would love it if you'd share it with OB friends of yours so that everybody is ready for January. Hopefully, you guys have a great rest of your day and a great uh Fourth of July holiday.