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PAP304 - Prenatal and Postpartum Care Coding for HEDIS Quality - New
Blue Cross of Idaho·ID · OB-GYN, Family Medicine, Internal Medicine·Coding
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho has introduced new coding guidelines for prenatal and postpartum care to support HEDIS quality measures. The policy establishes specific documentation requirements and billing codes for prenatal visits (first 12 weeks of pregnancy) and postpartum visits (7-84 days after delivery) to ensure proper quality measure reporting.
Action Required
Immediately: Providers must ensure prenatal visits within first 12 weeks of pregnancy or within 42 days of enrollment include comprehensive documentation (pregnancy flow sheet, ACES assessment, LMP, EDD, gestational age, positive pregnancy test, gravidity/parity, obstetrical history, risk assessment, physical exam with fetal heart tones or pelvic exam, and prenatal procedures). For postpartum visits (7-84 days after delivery), document postpartum care notation plus at least one required element (cervical cytology, pelvic exam, weight/BP evaluation, breast/abdomen evaluation, incision check, depression screening, or family planning discussion). Use appropriate CPT codes for bundled services or stand-alone visits with pregnancy diagnosis codes to support HEDIS quality measure reporting.