Special Delivery
The SMFM ENewsletter


President's Forum 
Sean C. Blackwell, MD
Dear Colleagues:  
As SMFM grows in size, it is imperative our leadership style and priorities evolve, as well. Communication and transparency are two key elements we are working to improve.
We have recently taken two steps to address this: 1.) each member of the Board of Directors and staff is listed on the SMFM website, along with his or her email address, and 2.) a virtual suggestion box has been created on the SMFM website. The feedback provided here is anonymous and shared with SMFM's CEO, Matt Granato, and the SMFM president on a weekly basis.
Our contact information will remain easily available to the members and we hope that you will use it. In doing so, the goal is to make the Society more inclusive and transparent.
Most recently, the SMFM's leadership had the opportunity to share information that was very important to many members regarding the choice of a gift to celebrate Dan O'Keeffe's retirement. The Executive Committee outlined the decision making process and responded directly with a statement on the SMFM Facebook group and the SMFM website. 
Another issue that has been brought to the Board's attention is suboptimal correspondence following application to serve on SMFM committees. There are many members interested in participation and not all will be selected for this service. Later this year, we will share how the selection process works, the current make-up of the committees, and our new efforts to better communicate following the application process.
In the meantime, the Board and staff contact information will remain easily available to the membership and we hope that you will use it. In doing so, the goal is to make the Society more transparent and increase access for members to have their voice heard.
Sean C. Blackwell, MD
MFM Coding
Registration is Open for the Spring Coding Course    
New ICD-10 codes went into effect in October 2017, including an expansion of the Z36 series with specific codes needed for maternal-fetal medicine. Learn more at S MFM's next Coding Course o n May 10-11, 2018 in Long Beach. 
Visit the SMFM website to register for the course and secure a hotel room. Hotel reservations must be made by April 20 to enjoy the discounted, group rate of $189/night. 
Coding Tip #1: The Use of Delivery Codes by the MFM Physician 
Because of the nature of MFM practice, the selection of delivery codes can be challenging. The chart below will help in understanding the purpose of these CPT codes in the context of MFM practice.
VBAC  Attempted
Notes and Comments 
 59400  59510  59610  59618
Use: When a single physician/group provides all obstetric care related to a given pregnancy.
Includes: All antepartum care, delivery, and postpartum services (including both inpatient and outpatient care). Those services "normally" provided in "uncomplicated" cases.
Excludes: Ultrasounds, BPPs, NSTs, most obstetric procedural services. Additional E/M services provided by the physician billing globally for all visits exceeding 13 encounters during the pregnancy.  
Delivery Only
Use: When the billing provider only supplies the delivery service, OR supplies the delivery service and less than all the antepartum care.
Includes: The management of the delivery service, including the E/M services provided the calendar day before the delivery.
Excludes: Any antepartum services provided, and any postpartum services (both inpatient and outpatient) beginning the calendar day after delivery. 
Delivery with  
Postpartum Care

 59410  59515  59614  59622
Use: When the billing provider supplies the delivery service AND plans to provide all postpartum services (including both inpatient and outpatient care).
Includes: The management of the delivery service, including the E/M services provided the calendar day before the delivery and all routine postpartum services.
Excludes: Any antepartum services provided, any procedural services provided in the postpartum period, any postpartum E/M services related to complications. 

Though many MFM practices are consultative only in nature, those MFM groups that provide full prenatal care should use the above coding practices when they provide global prenatal care.

There needs to be clear channels of communication between the MFM physician and the primary obstetric provider (i.e. specialist obstetrician, family practitioner, nurse practitioner or midwife) if there is co-management of a patient or a transfer of care, to ensure that each party understands their responsibility and that the billing accurately matches the reality (i.e. who has primary responsibility for postpartum care).  Please refer to the SMFM document "
Levels of Maternal Care" ( AJOG, March 2015).


Individual payers may have rules/guidelines that differ from the standard guidelines. For example, some state Medicaid programs may include inpatient postpartum days in the "delivery only" codes or some payers may allow global billing if more than one provider/practice has supplied antepartum services. Knowledge of payer policies is critical for success in properly reporting delivery services.


Coding Tip #2: ICD-10 Coding - Size/Dates Discrepancy vs. Fetal Growth Issues 
Use of the uterine size/dates discrepancy code set (O26.841-O26.849) is appropriate when the measurement between the symphysis pubis and the top of the fundus is not consistent with the stated dates. There may be a diagnosis of uterine size/dates discrepancy, whether the fetus itself is large, small, or appropriately sized.
The ICD-10 codes for poor fetal growth (O36.5910-O36.5999) or excessive fetal growth (O36.60X0-O36.63X9) should be used when the fetus measures either small or large for dates.
The codes for uterine size/dates discrepancy and poor or excessive fetal growth may be used together if the conditions coexist.
Example: 27 week singleton with poor fetal growth, and uterine size/dates discrepancy:
O36.5920         Maternal care for other known or suspected poor fetal growth
O26.842           Uterine size-date discrepancy complicating pregnancy
Z3A.27              27 weeks gestation
Go to top of page

Practice Management
NEW! SMFM Launches Consulting Services  
SMFM is pleased to announce the availability of practice management services to our members. Whether your concern is achieving profitability in a solo practice setting, alignment with your parent organization in a health system employment model, or department planning in a university setting, our  expertise will be an invaluable resource in achieving your goals. To learn more about how we can help your organization maximize its potential, contact Tim Heinle at theinle@smfm.org or +1 (202) 517-6353.

Factors Impacting MFM Compensation 
A recent article from Dr. Jim Keller
addresses some of the changes in health care economics that impact the field. Read the article, which is available in the Practice Management Library.  Some of the same issues were discussed in greater detail during a members-only Practice Management webinar. If you missed it, view the recorded version here
Join our Online Communities
Connect with SMFM Members Online
Participate in our Online Communities to collaborate, share advice, discuss clinical challenges, and connect with SMFM members worldwide. The online communities are free for  members and do not require any sign up. Simply login to your SMFM account and visi t communities.smfm.org to access the communities today. If you have any questions or need assistance you can contact Tim Heinle, Member Services Manager, theinle@smfm.org.
Fellow Lecture Series
Save the date for the upcoming MFM Lecture Series, which will take place on March 21 and April 4 at 12:00 - 1:00 pm (ET).   No advanced registration is required to participate, simply click here shortly before noon on the day of the event. Upcoming topics and presenters include:         

John Smulian, MD 
Postpartum Hemmorage and TXA on March 21 
Heather Lipkind, MD
A Toolkit for MFM Fellows: Understanding and Overcoming 
 Burnout on April 4 
If you are unable to join live, visit the SMFM website for the recorded version of past webinars. Watch at your leisure and learn from some of the world's leading experts in high-risk pregnancy.  Questions? Contact Chris Coleman at ccoleman@smfm.org. 

Go to top of page 
Health Policy and Advocacy
SAVE THE DATE! State Liaison Network Webinar             
The State Liaison Network is hosting a no-cost webinar on Friday, April 13 at 5:00 pm (ET) that will dig deeper into Maternal Mortality Review Committees. Hear from the CDC abou t the elements necessary for public health data collection, as well as from physicians who are actively engaged in leading MMRCs in their states. To join the webinar, please email Katie Schubert at kschubert@smfm.org. The webinar will be recorded and posted for viewing later if you aren't able to join us live. 
Policy Riders Threaten Omnibus Spending Bill
Despite the bipartisan budget agreement in February, the federal government faces another deadline - March 23 - of yet another shutdown. While Congress and the President agreed to overall spending levels for FY2018 and FY2019 (NOTE: fiscal year 2018 began October 1, 2017), the  amount appropriated for individual programs has not been determined.  Because of the delay, Congress is currently negotiating and considering funding levels for both FY2018 and FY2019.

Complicating the passage of FY2018 legislation is the issue of "policy riders" - that is, instructions of spending (or not spending) money on specific policy areas, including family planning. SMFM has long supported passing so-called "clean" spending bills without policy riders to keep public health programs funded. 

SMFM's Chief Advocacy Officer, Katie Schubert, MPP, was on Capitol Hill last week with the Coalition for Health Funding advocating for public health programs related to maternal and infant health and to ensure that they are funded adequately in both the FY2018 and FY2019 spending bills. She heard from Members of Congress and their staff that there is a desire and expectation that a "clean bill" would ultimately be passed, which would allow the committees to move on to FY2019. The SMFM Health Policy and Advocacy Committee is currently working to support funding efforts for research and public health related to high-risk pregnancy for FY2019.

Foundation for SMFM
Apply for a Foundation Grant  

Applications for the 2019-2022   SMFM/AAOGF Scholarship are due by July 1. Our premier MFM research training grant provides up to three years of funding and mentoring for physician scientists who are fellows or junior faculty.

Go to top of p age
The  Queenan Fellowships for Global Health offer clinical and research opportunities for MFM specialists to impact maternal and child health in low-resource settings. Apply by July 1.
Apply for a Garite Mini-Sabbatical Grant by July 1. Up to $10,000 is available to fellows or practicing MFMs for a mentored clinical or research project at another institution. 

Global Health
An Update from the Global Health Committee
by Dr. Phillip Greig

The 2018 Annual Meeting was an exciting time for the Global Health Committee. We spent an entire day hearing from the different members from the African Coalition for Excellence in Obstetric and Neonatal Care. We also heard presentations from members working in South America. 

There is a tremendous need to improve the care of pregnant women and neonates around world. These vulnerable patients are dying at an unacceptable rate. Basic improvements in prenatal and delivery care can have a huge life-saving impact. SMFM and its members are involved in changing these outcomes through partnering with medical centers around the globe to teach the national physicians. These partnerships will have a long term, sustainable impact.

We welcome and encourage SMFM members who are already working around the world or those who have considered getting involved with work outside of the United States, to join our Global Health Community Group or contact Phillip Greig, MD.   

Fellows Corner
An Update from the Associate Members Meeting
by Drs. Audrey Merriam and Andrew Lane
Thanks to everyone who attended the Associate Members Meeting in Dallas, despite its overlap with a poster session. We would also like to thank everyone who voted in the elections either in person or online. The results of the election are:
  • Whitney Booker, MD of Columbia University Medical Center will serve as the Associate Member Representative to the SMFM Board from 2019-2021
  • Masaru Negi, MD of Yale University will serve as the Practice Management Division Representative
Congratulations Whitney and Masaru and thank you to everyone who ran. For those of you who could not attend the meeting we wanted to provide some information on what was discussed.


Class Representative Position

  • Details of this position are still being finalized, but will include things such as coordinating the class gift to the Foundation for SMFM, volunteering to help during events at the Annual Meeting, promoting fellow events within your class
  • If you are interested and have not signed up yet or want to see if you are signed up please email Audrey at aamerr02@gmail.com
SMFM Website
  • Research Consult for Fellows: This service will match a fellow with a mentor to address their specific question. The goals are to provide advice, troubleshooting, brainstorming, networking and a local repository for manuscripts and resources to conduct research. Learn more on the SMFM website or email Dr. Bob Silver (bsilver@hsc.utah.edu) with your question.
  •  SMFM is currently accepting applications for service on the 2019 Committees.  Applications will be accepted until this summer and reviewed in September and October. Learn more on the SMFM website
We look forward to seeing everyone again next year. And, as always, if you have any questions or concerns in the meantime please email Audrey at aamerr02@gmail.com.
SMFM's Annual Meeting
2018 Annual Meeting 
Did you miss the Annual Meeting? From TRAAP to ARRIVE, watch streaming videos of the Presidential Plenaries here. Please note: mobile viewing may not be possible from your device. If so, please try viewing from a desktop computer.

2019 Annual Meeting  
Planning is underway for the 2019 Annual Meeting in Las Vegas.  Please save the date! February 11-16, 2019.
Member Profile
Is Your Member Profile Up-To-Date?
Please take a moment to log in to your account at www.smfm.org/profile to make sure all of your contact information is correct. This will ensure that you receive your AJOG journal, timely notifications related to your membership, information on upcoming events, and more. If you have any questions or need assistance please contact Tim Heinle, Member Services Manager, theinle@smfm.org .

To ensure you will not lose any of future updates from SMFM due to a spam filter error, please add SMFM@smfm.org to your address book or "safe-senders list."