Postpartum Insurance Coverage Period Extended to 12 Months in 4 States – Here’s How to Code the Expansion

Postpartum Insurance Coverage Period Extended to 12 Months in 4 States – Here’s How to Code the Expansion

CMS has expanded its Medicaid and Children’s Health Insurance Program (CHIP) coverage for postpartum care from 60 days to 12 months in select states. Now, individuals in California, Florida, Kentucky, and Oregon have access to extended postpartum coverage for 12 months regardless of the reason their pregnancy ends.

The extended insurance coverage will support an additional 126,000 families across these states annually. The expansion results from efforts to improve postpartum maternal care, including childbirth recovery, mental health services, infant care, and more. Additionally, lower maternal morbidity and mortality rates are tied to the timely delivery of postpartum care.

How to Code the Extended Postpartum Period

Per ICD-10-CM guidelines, the postpartum period is six weeks after delivery, and the peripartum period is through 5 months postpartum (presented in the table below). As a result, the newly expanded Medicaid postpartum period will not be based on postpartum or peripartum ICD-10-CM diagnosis codes. It will be based on ICD-10-CM diagnostic delivery codes and the date of delivery.

A statement from the Department of Health and Human Services (HHS) and CMS declares, “The 12-month postpartum period begins on the last day of a beneficiary’s pregnancy and extends through the end of the month in which the 12-month period ends. Similar to the current 60-day postpartum period, under the extended postpartum coverage option, individuals are entitled to extended postpartum coverage regardless of the reason the pregnancy ends. States that do not elect the extended postpartum coverage option must continue to provide coverage for pregnant individuals in Medicaid through the 60-day postpartum period as currently required.”

Accurate code assignment within the ICD-10-CM Chapter 15: Pregnancy, childbirth, and the puerperium (codes O00-O9A), as well as the date of delivery, is essential. Additional ICD-10-CM codes from category Z3A “Weeks of gestation” and category Z37 “Outcome of Delivery” (i.e., single live birth, twins, triplets, etc.) must also be assigned correctly.

YES HIM Consulting’s coding subject matter experts can assist your team with understanding these new guidelines for the applicable states. Reach out to our team to discuss our coding support and education solutions.

Karen Youmans

Karen G. Youmans, MPA, RHIA, CCS – President, YES HIM Consulting, Inc. AHIMA-approved ICD-10-CM/PCS trainer
medicaid postpartum coverage by state

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