GYN Billing and Coding Guide

Obstetrics & Gynecology is a subspecialty of medicine that focuses on the care of women during pregnancy and childbirth, as well as the diagnosis and treatment of illnesses of the female reproductive organs. Additionally, it focuses on other aspects of women’s health, such as menopause, hormonal imbalances, contraception (birth control), and infertility.

An OB/GYN office performs a variety of operations, including surgeries, pre-and postnatal care, and routine health checks for women. Complexities in OB/GYN billing Ob/GYN billing and coding can be difficult for the majority of billers and coders due to global claims, widely variable coverage terms, and many tests conducted at multiple locations. Apart from that, many OB/GYN practitioners lack the billing help that large hospitals receive. The following are some common billing and coding problems that occur in OB/GYN billing and coding:

GYN Billing and Coding Guide

  • During the worldwide era, ignoring separately billable services delivered
  • Inability to comprehend that pregnancy coverage is an add-on to an existing insurance policy
  • Pregnancy coverage is divided between inpatient and outpatient care.
  • Inadequate documentation of policies and services offered
  • To code for the various levels of ground and air ambulance services employed, it is necessary to have a firm grasp on the criterion that constitutes “medical necessity.”
  • Recognize that diagnostic laparoscopy is required for all laparoscopic OB/GYN surgical procedures.

To maximize reimbursement for delivered services, quality obstetrics, and gynecology medical billing is required. To manage revenue effectively, medical claims must be filed to payers on time to ensure timely reimbursement. You may require the assistance of a reputable service provider to ensure efficient claim processing.

Our medical billers are highly skilled in all facets of OB/GYN coding. They remain current on medical codes and the operations they denote.

  • 76801 – Ultrasound of the pregnant uterus, real-time with picture documentation, evaluation of the fetus and mother, first trimester (14 weeks 0 days), transabdominal approach; single or first gestation
  • 76815 – Ultrasound, pregnant uterus, real-time with picture documentation, restricted (e.g., fetal heartbeat, placental position, and/or qualitative amniotic fluid volume), one or more fetuses
  • 76817 — Transvaginal ultrasound, pregnant uterus, real-time with photographic documentation

We utilize proper CPT, ICD-10, and HCPCS Level II codes, as well as relevant modifiers, to ensure maximum compensation and the fewest claim rejections.

OB Period

The obstetric (OB) period begins on the date of the initial appointment during which pregnancy was confirmed and ends at the conclusion of the postpartum period for billing reasons (56 days after vaginal delivery and 90 days after C-section).

Global Period Doesn’t Cover Everything

Oftentimes, services performed during the global era of another service go unnoticed. Prenatal and postpartum visits in the ‘typical’ manner are included in the worldwide delivery package. Yeast infections, vaginitis, and sexually transmitted illnesses (STDs) are not included in the global delivery package. Non-pregnancy-related problems may be individually paid at the time of service or treatment.

Antepartum Care

‘Antepartum care only codes’ should be paid when a practitioner or group of practitioners will not be performing all three components of global OB care (more than 3 antepartum visits, delivery, and postpartum care). Per pregnancy, only one antepartum care code may be billed.

antepartum visits are performed – bill appropriate E/M codes for the visits

4-6 antepartum visits – Bill 59425

7-14 antepartum visits – Bill 59426

More than 14 antepartum visits due to complications of pregnancy – Bill 59426 and append the 22 modifier to indicate increased services.

Delivery

Delivery begins on the day of the member’s initial hospitalization for delivery and continues until the member is discharged from the hospital. Hospital treatment associated with the delivery is included in the delivery charge and is NOT included in postpartum care. If a C-section is done, the reimbursement for the delivery only charge covers both the surgical operation and post-operative treatment.

Vaginal delivery only – bill 59409

C-section delivery only – bill 59514

VBAC delivery only – bill 59612

C-section after attempted VBAC delivery only – bill 59620

Postpartum Care

Postpartum care begins upon discharge from the hospital following birth and continues throughout the postpartum period (56 days for vaginal delivery and 90 days for cesarean delivery).

  • Postpartum care only – bill 59430
  • When a clinician provides delivery and postpartum care but does not provide antepartum care, the provider should bill the appropriate delivery and postpartum code.
  • Vaginal birth with postpartum care – bill 59410 C-section birth with postpartum care – bill 59515
  • Vaginal birth following cesarean delivery (VBAC) – bill 59614 C-section following attempted VBAC – bill 59622