Ob/Gyn Coding Guidelines
Obstetrics and gynecology/maternity care services:
Antepartum care
Deliver services
Postpartum care
The 2 types of OB coding and billing guidelines are given below:
Global OB Care
The total obstetrical care package includes the provision of antepartum care, delivery services, and postpartum care. When the same group physician and/or health care professional provides all components of the OB package, report the Global OB package code.
CPT Codes for Global OB
CPT code 59400 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care.
CPT code 59510 - Routine obstetric care including antepartum care, cesarean delivery, and postpartum care.
CPT code 59610 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery.
CPT code 59618 - Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery.
The global maternity allowance is a complete, one-time billing which includes all professional services for routine antepartum care, delivery services, and postpartum care. The fee is reimbursed for all of the member’s obstetric care to one provider. If the member is seen four or more times prior to delivery for prenatal care and the provider performs the delivery, and performs the postpartum care then the provider must bill the global OB code. Global maternity billing ends with release of care within 42 days after delivery. Global OB care should be billed after the delivery date/on delivery date.
Services included in global obstetrical package.
Routine prenatal visits until delivery, after the first three antepartum visits.
Recording of weight, blood pressure, and fetal heart tones.
Admission to the hospital including history and physical.
Inpatient E&M service provided within 24 hours of delivery.
Management of uncomplicated labor.
Vaginal or cesarean section delivery.
Delivery of placenta (CPT code 59414)
Administration/induction of intravenous oxytocin (CPT code 96365-96367)
Insertion of cervical dilator on same date as delivery (CPT 59200)
Repair of first or second degree lacerations.
Simple removal of cerclage (not under anesthesia)
Uncomplicated inpatient visits following delivery.
Routine outpatient E&M services provided within 42 days following delivery.
Postpartum care after vaginal or cesarean section delivery (CPT code 59430)
The above mentioned services are not separately reimbursed when reported separately from global OB code.
Services excluded from the global obstetrical package.
First three antepartum E&M visits.
Laboratory tests.
Maternal or fetal echography procedures.
Amniocentesis, any method.
Amniofusion.
Chronic villus sampling.
Fetal contraction stress test.
Fetal non-stress test.
External cephalic version.
Insertion of cervical dilator more than 24 hr before delivery.
E&M services which are unrelated to the pregnancy (example UTI, asthma, etc) during antepartum or postpartum care.
Additional E&M visits for complications or high risk monitoring resulting in greater than the typical 13 antepartum visits. However, these E&M services should not be reported until after the patient delivers. Append modifier 25 to identify these visits as separately identifiable from routine antepartum visits.
Inpatient E&M visits provided more than 24 hours before delivery.
Management of surgical problems arising during pregnancy ( example cholecystectomy, appendicitis, ruptured uterus)
Non-global OB care, or partial services
Non-global OB care, or partial services, refers to maternity care not managed by a single provider or group practice. Billing for non-global OB or partial care may occur if,
A patient transfers into or out of a physician or group practice
A patient is referred to another physician during her pregnancy
A patient has the delivery performed by another physician or other health care professional not associated with her physician or group practice
A patient terminates or miscarries her pregnancy
A patient changes insurers during her pregnancy
The physician provide only partial services instead of global OB care, to bill for that portion of maternity care only. Use the codes below for billing antepartum-only, postpartum-only, delivery-only, or delivery and postpartum only services
Only one of the following options should be used, not a combination.
A. Antepartum Care only
For 1 to 3 visits: Use E&M office visit codes
For 4 to 6 visits. Use CPT 59425, This code must not be billed by the same provider in conjunction with one to three office visits, or in conjunction with code 59426.
For 7 or more visits. Use CPT 59426 - Complete antepartum care is limited to one beneficiary pregnancy per provider.
Billing guidelines of antepartum care only. IF the pateint is treated for antepartum services only, the physician should use CPT 59426 if 7 or more visits are provided, CPT code 59427 if 4-6 visits are provided, or each E&M visit if only providing 1-3 visits.
A single claim submission of CPT code 59425 or 59426 for the antepartum care only, excluding the confirmatory visit that may be reported and separately reimbursed when the antepartum record has not been initiated.
The units report should be 1 (one).
The dates reported should be the range of time covered, example If the patient had a total of 4-6 antepartum visits then the physician should report CPT code 59425 with the from and to dates for which the services occurred.
CPT 59425 and 59426 - These codes must not be billed together by the same provider for the same beneficiary, during the same pregnancy.
Pregnancy related E&M visits must not be billed in conjunction with code 59425 or 59426 by the same provider for the same beneficiary, during the same pregnancy.
B. Delivery services only
The following are the CPT codes for delivery services only:
CPT code 59409 - vaginal delivery only (with or without episiotomy and/or forceps)
CPT code 59414 - Cesarean delivery only
CPT code 59612 - vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps)
CPT code 59620 - Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery
The delivery only codes should be reported by the same group physician for a single gestation when, the total OB package is not provided to the patient by the same physician or group practice or only the delivery component of the maternity care is provided and the postpartum care is performed by another physician or group of physicians.
Services included in the delivery services:
Admission to the hospital
The admission history and physical examination
Management of uncomplicated labor, vaginal delivery (with or without episiotomy, with or without forceps), or cesarean delivery, external and internal fetal monitoring provided by the attending physician
Intravenous induction of labor via oxytocin ( CPT code 96365-96367)
Delivery of the placenta, any method
Repair of first or second degree lacerations
Insertion of cervical dilator (CPT 59200) to be included if performed on the same date of delivery
C. Delivery only including postpartum care
If the same individual or same group physician provided the delivery care and postpartum care, in these instances few CPT codes encompass both of these services, the following are CPT defined delivery and postpartum care.
59410 - vaginal delivery only including postpartum care
59515 - cesarean delivery only, including postpartum care
59614 - vaginal delivery only, after previous cesarean delivery, including postpartum care
59622 - cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery, including postpartum care
Services included in the delivery only including postpartum care services
Hospital visits related to the delivery during the delivery confinement
Uncomplicated outpatient visits related to the pregnancy
Discussion of contraception
D Postpartum care only
The following is the CPT defined postpartum care only, 59430 - Postpartum care only (separate procedure)
Services included in the postpartum care
Uncomplicated outpatient visits related to the pregnancy
Discussion of contraception
Services excluded in the postpartum care
E&M of problems or complications related to the pregnancy