OB/GYN Billing and Coding Guidelines

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OB and GYN is a branch of medicine that specialize in women’s care during the pregnancy and childbirth, and in diagnosing and treating diseases of the women reproductive organs. Also, it specializes in other women’s health problems, such as menopause, hormone issues, contraception and infertility.

OB/GYN Billing and Coding Guidelines

Obstetrics and Gynaecology care services:

  1. Antepartum care
  2. Delivery services
  3. Postpartum care

The types of OB Billing and Coding guidelines are given below:

  1. Global OB Care
  2. Non-global OB care or partial services

Global OB Care

The package of global obstetric care includes the antepartum care, delivery services and also the postpartum care. When the same group physician or other health care professional provides all components of the global obstetric care package, just report the Global OB package code.

OB GYN Billing and Coding Guidelines
The CPT Codes for Global Obstetric (OB)

  • CPT code 59400
    Routine OB care including the antepartum care, postpartum care and vaginal delivery.
  • CPT code 59510
    Routine OB care including the antepartum care, the postpartum care and the cesarean delivery.
  • CPT code 59610
    Routine OB care including the antepartum care, the vaginal delivery and postpartum care, after previous cesarean delivery.
  • CPT code 59618
    Routine OB care including the antepartum care, cesarean delivery, and postpartum care that following vaginal delivery once previous cesarean delivery.

Global Obstetric (OB) Billing Guidelines

The global maternity subsidy is a complete one-time billing that includes all services for routine antepartum care, postpartum care and delivery services. The fee is reimbursed for all of the member’s global obstetric care to one provider. If the member is seen 4 or more times prior to delivery for prenatal care and the provider acts the delivery, and also acts the postpartum care, then the provider need to bill the Global OB code. Keep in mind that Global Obstetric maternity billing ends with the release of care within 42 days after delivery services. Global OB care must be billed after the delivery date or on delivery date.

Services Included in Global Obstetrical (OB) Package

  • Routine prenatal visits until delivery, once the first three antepartum visits.
  • Recording of the blood pressures, weight and fetal heart tones.
  • Admission to the hospital including the history and physical.
  • Inpatient Evaluation and Management service given in 24 hours of delivery.
  • Management of uncomplicated labor.
  • Vaginal or cesarean section delivery.
  • Delivery of placenta.
  • Induction of intravenous oxytocin.
  • Insertion of the cervical dilator on same date as delivery.
  • Repair of the first or second degree lacerations.
  • Removal of cerclage (not under anesthesia).
  • Uncomplicated inpatient visits following delivery.
  • Routine outpatient Evaluation and Management services provided within 42 days following delivery.
  • Postpartum care, once the vaginal or cesarean section delivery.

For note: The services mentioned above are not separately reimbursed when reported separately from the global OB code.

Non-Global OB Care (Partial Services)

Non-global OB care refers to maternity care which is not run by a provider or group practice. Some reasons that make Billing for non-global OB occur:

  • The patients transfer into or out of a physician or group practice.
  • The patients are referred to another physician during their pregnancy
  • The patients have the delivery performed by another physician or other health care professional not associated with their physician or group practice
  • The patients terminate or miscarry their pregnancy.
  • The patients change insurers during their pregnancy

The physician give only partial services instead of global OB care to bill for that portion of maternity care only. You are able to use the codes below for billing postpartum-only, antepartum-only, delivery-only, or delivery and postpartum only services.

Warning: Just one of the following choices should be used, not a combination.

A. Antepartum Care Only

  • For 1 to 3 visits: You are able to use E/M office visit codes.
  • For 4 to 6 visits: You will be able to use CPT 59425. For your information, this code should not be billed by the same provider.
  • For 7 or more visits: You are able to use CPT 59426.

B. Delivery Services Only

Here are some CPT codes for Delivery services only:

  • CPT code 59409
    Vaginal delivery only (Without or with forceps/Episiotomy)
  • CPT code 59514
    Cesarean delivery only
  • CPT code 59612
    Vaginal delivery only, once previous cesarean delivery (Without or with episiotomy and or forceps)
  • CPT code 59620
    Cesarean delivery only, following tried vaginal delivery once previous cesarean delivery

C. Delivery Only Including Postpartum Care

Here are the CPT defined delivery and postpartum care:

  • CPT code 59410
    Vaginal delivery only (without or with forceps and or episiotomy) including the postpartum care.
  • CPT code 59515
    Cesarean delivery only including the postpartum care.
  • CPT code 59614
    Vaginal delivery only, once previous cesarean delivery (with or without episiotomy and or forceps); including the postpartum care.
  • CPT code 59622
    Cesarean delivery only, following tried vaginal delivery after previous cesarean delivery; including the postpartum care.

Service Included in The Delivery Only Including Postpartum Care Services

  • Hospital visits regarding delivery during delivery confinement.
  • Uncomplexed outpatient visits regarding the pregnancy.
  • Discussion about the contraception.

D. Postpartum Care Only

The below is the CPT defined postpartum care only:

  • CPT 59430
    Postpartum care only (separate procedure)

Services Included in The Postpartum Care

Here are services included in the Postpartum care

  • Uncomplexed outpatient visits regrading the pregnancy.
  • Discussion about the contraception.

Services Excluded in The Postpartum Care

Here are services excluded in the Postpartum care

  • E/M of issues or complications related to the pregnancy

Billing Guidelines for Postpartum Care Only

You have to know that the postpartum care only must be reported by the same group physician that gives the patient with services of postpartum care only. If a physician gives the antepartum care along with the postpartum care, but he or she does not do the delivery service, then the services need to be itemized by utilizing the suitable counterpart care code and the postpartum care code.

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