CommercialDocumentationMedium impact
Proper Documentation and Coding to Accurately Capture HEDIS PPC Measure
Medical Mutual of Ohio·OH · OB-GYN, Family Medicine·Coding
We identified it
Jun 20, 2026
Summary
Medical Mutual of Ohio has released new documentation and coding requirements to improve capture of HEDIS PPC (Prenatal and Postpartum Care) measures. Billing teams must ensure prenatal visit codes are accompanied by pregnancy diagnosis codes and use specific CPT/ICD-10 codes for prenatal and postpartum care to reduce chart review requirements.
Action Required
Immediately: Billing team must update coding practices to ensure all prenatal visit codes (99203, 99204, 99213, 99214, G0463) are paired with appropriate pregnancy diagnosis codes (O26.899, O26.90, O26.91, O36.70X0, O36.72X0, Z34.80, Z34.90). For postpartum bundled services (59400, 59510, 59610), ensure date of care is documented and these codes are NOT billed on delivery date. Update encounter forms and EMR templates to include required pregnancy diagnosis codes for prenatal visits.