OB/GYN billing basics: what makes It unique?

OB/GYN billing basics: what makes It unique?

OB/GYN Billing Basics: What Makes It Unique?

Billing for OB/GYN services brings together elements of preventive care, surgical coding, and global obstetrical billing—making it one of the most distinctive specialties in the medical billing landscape. To bill accurately, you’ll need to understand how bundled services, split care, and payer policies interact.

Here’s a breakdown of what makes OB/GYN billing unique and what to watch for.

1. Global Obstetrical Billing Isn’t Just One Code

Unlike most specialties, OB services are often billed as a global package that includes prenatal care, delivery, and postpartum care. But not every payer follows the same global rules—and not every provider delivers the full package.

What to watch for:

  • Global billing typically includes 13+ prenatal visits, delivery, and postpartum care

  • Use CPT code 59400 for vaginal delivery, 59510 for cesarean—only if all care is provided

  • For split or transferred care, use individual codes (e.g., 59425, 59426, 59409, 59430)

  • Document exact services and timeline—especially for patients switching providers

Tip: Some payers require prenatal visits to be billed individually if fewer than four visits are provided.

2. Well-Woman Exams and Problem Visits May Be Billed Separately

Preventive exams are a core part of OB/GYN care—but patients often bring up separate problems during the same visit.

What to watch for:

  • Annual well-woman exams: 99384–99397 (based on age)

  • Add modifier -25 to a problem-based E/M (e.g., 99213) done on the same day

  • Clearly document the distinct reason for the problem-focused service

Tip: Always verify payer policy—some may not allow both codes on the same day without prior auth or documentation.

3. Surgical Coding Involves Multiple Approaches and Modifiers

OB/GYNs perform a wide range of procedures—from in-office biopsies to laparoscopic hysterectomies. Surgical billing requires precision, especially when multiple procedures are performed at once.

What to watch for:

  • Use modifier -51 for multiple procedures

  • Modifier -59 or -XS may be needed to unbundle services

  • Check for bilateral procedure rules and global periods

Tip: Hysteroscopies, endometrial ablations, and D&Cs all have specific documentation needs—make sure the op report supports the codes billed.

4. Ultrasound Billing Is Common—but Requires Detail

OB/GYNs frequently perform and interpret ultrasounds in-house. These services are separately billable, but only if they meet technical and documentation requirements.

What to watch for:

  • Use codes like 76801 (first trimester), 76805 (second/third trimester), or 76815 (limited)

  • Modifier -26 if billing for interpretation only

  • Document medical necessity, gestational age, and findings

Tip: Repeated “routine” ultrasounds without justification may trigger denials or audits.

5. Family Planning Services Have Unique Coding Rules

Contraceptive counseling, IUD insertion/removal, and sterilization procedures are all common—but coding varies by payer and plan.

What to watch for:

  • Use both procedure and device codes (e.g., 58300 + J7300 for IUD)

  • Document counseling and informed consent clearly

  • Be aware of payer carve-outs for Medicaid family planning coverage

Tip: Some contraceptive services are covered at 100% under ACA—but only when billed correctly.

6. Be Diligent with Pregnancy Diagnoses and Timelines

ICD-10 pregnancy codes are trimester-specific and require attention to detail. Getting them wrong can lead to denials or inaccurate risk adjustment.

What to watch for:

  • Use O00–O9A series codes for pregnancy-related diagnoses

  • Always include the weeks of gestation (Z3A.XX) when appropriate

  • Update codes throughout the pregnancy as conditions change

Tip: Avoid using Z34 (“normal pregnancy”) alongside complication codes—it’s either one or the other, not both.

Conclusion:

OB/GYN billing isn’t just about CPT and ICD codes—it’s about timing, documentation, and understanding how bundled care works across prenatal, delivery, and postpartum services. With so many moving parts, it's easy to miss out on revenue—or unintentionally overbill—if you're not careful.

    • Related Articles

    • Primary care vs. specialty care billing: What sets them apart?

      Primary Care vs. Specialty Care Billing: What Sets Them Apart? At first glance, billing for primary care and specialty care may seem similar—both involve CPT codes, modifiers, and payer rules. But beneath the surface, the workflows, coding habits, ...

    • Billing for mental health providers: Key differences and best practices

      Billing for Mental Health Providers: Key Differences and Best Practices Billing for mental health services isn’t the same as billing for general medical care. It comes with its own set of codes, coverage rules, and documentation expectations. For ...

    • Common Pitfalls in Pediatric Billing—and How to Avoid Them

      Common Pitfalls in Pediatric Billing—and How to Avoid Them Pediatric billing might seem straightforward, but it comes with its own set of unique challenges. From frequent well-child visits to age-specific vaccine schedules and coordination with ...

    • Billing for pain management practices: What to watch for

      Billing for Pain Management Practices: What to Watch For Pain management billing combines elements of primary care, anesthesia, and interventional procedures—all under one roof. It’s a high-revenue specialty, but it’s also one of the most closely ...

    • What is unique about billing and coding for urgent care?

      What is unique about billing and coding for urgent care? Billing and coding for urgent care centers involves a unique set of challenges and requirements that differentiate it from other outpatient or primary care settings. Urgent care centers operate ...