Summary & Overview
HCPCS G9358: Postpartum Screenings, Evaluations and Education Not Performed
HCPCS Level II code G9358 captures instances when postpartum screenings, evaluations and patient education were not performed. Nationally, accurate reporting of service non-performance matters for quality measurement, care coordination, and claims integrity because postpartum screening—particularly for mood disorders and recovery complications—is a standard component of maternal care pathways. Documentation of non-performance can affect quality metrics and payer reporting requirements.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what G9358 represents, the clinical and billing context for its use, and where the service typically occurs. The publication outlines benchmarks and policy implications relevant to payers and providers, summarizes common modifier usage when provided, and highlights areas where documentation and coding clarity are frequently required.
This national overview is intended for coding professionals, revenue cycle managers, maternal health clinicians, and payer policy analysts seeking clear guidance on the purpose and reporting implications of G9358. It does not provide clinical recommendations but focuses on coding interpretation, operational impact, and where to expect administrative scrutiny.
Billing Code Overview
HCPCS Level II code G9358 denotes post-partum screenings, evaluations and education not performed. This code is used to report the absence of postpartum assessment services that would normally include screening for postpartum depression and other postpartum health evaluations, plus education provided to the birthing person and family.
Service Type: Postpartum screening and education non-performance
Typical Site of Service: Obstetric clinic, hospital outpatient department, or other ambulatory maternal health settings where postpartum screenings and education would ordinarily occur.
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Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a postpartum patient who did not receive recommended postpartum screening, evaluation, or education during the standard postpartum visit window. For example, a 28-year-old patient presents for a routine postpartum clinic follow-up at 6 weeks after vaginal delivery; due to early discharge, missed appointment, patient refusal, or acute illness at the visit, the standard postpartum assessments (mental health screening, blood pressure check, lactation counseling, contraceptive counseling, wound check if applicable) were not performed. The clinical workflow begins with scheduling or attempting a postpartum visit, triage by nursing to identify needed services, and documentation of services planned. When the clinician documents that postpartum screenings, evaluations, or education were not performed and records the reason (for example, patient declined, patient unstable, or services deferred), billing uses G9358 to indicate post-partum services were not performed. Typical site of service includes outpatient clinics, obstetrician/gynecology office, family medicine clinics, and hospital outpatient departments. Common reasons for not performing services include patient no-show, early discharge without completed counseling, acute medical issues precluding screening, or transfer of care; the scenario may also involve coordination for rescheduling or alternative delivery of education (telehealth, written materials) documented in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |