Contrary to other areas of the American Medical Association, Current Procedural Terminology, maternity, and obstetrical treatment have unique coding and billing requirements (CPT). “Global OB Care” refers to the full spectrum of prenatal, labor and delivery, and postpartum services for expectant mothers.
Global OB care is documented using the correct CPT code when the same group of doctors and other medical providers performs all parts of the OB package. Traditional antenatal care, labor and delivery, and postpartum care are all included in maternity services. The provider may: Based on the patient’s situation and insurance provider:
- Submit one CMS-1500 claim form covering all nine months of care for full-term deliveries.
- Send in claims for maternity care services that are itemized. (Most state Medicaid payers demand claim submission for each visit.)
Let’s discuss what you should know about medical billing for obstetric care throughout pregnancy.
Universal OB/GYN Billing Codes
- 59400 – Antenatal care, vaginal birth (with or without episiotomy and forceps), and postnatal care are all part of the standard obstetrical care routine.
- 59510 – Prenatal care, caesarean birth, and postpartum care are all common forms of obstetric treatment.
- 59610 – Regular obstetric care includes care before birth, delivery through the birth canal (with or without an episiotomy and forceps), and care after birth after a caesarean section.
- 59618 – Regular obstetric care, including antepartum care, delivery by caesarean section, and postpartum care, is necessary if an attempt is made to deliver the baby vaginally after a previous caesarean section.
| CPT | Interpretation | Package |
| 59409 | exclusively vaginal births, either
with forceps or an episiotomy; |
Identifier Code |
| 59410 | Only vaginal births
(epididymectomy or forceps are optional) are covered, along with postpartum care. |
Identifier Code |
| E/M | Just prenatal care, ranging from 1-3 visits. | Identifier Code |
| 59425 | Just prenatal care, with 4-6 visits | Identifier Code |
| 59426 | Just prenatal care; 7 sessions or more | Identifier Code |
| 59430 | Strictly postpartum attention (different process) | Identifier Code |
| 59514 | solely c-section births; | Identifier Code |
| 59515 | Only caesareans, with follow-up treatment included | Identifier Code |
| 59612 | Delivery by vaginal delivery exclusively, after a prior delivery by caesarean section (whether by episiotomy and forceps or not) | Identifier Code |
| 59614 | care during and after a second
vaginal delivery for women who have already had a caesarean delivery (forceps and an episiotomy, if necessary; postpartum care) |
Identifier Code |
| 59620 | Having another caesarean after a failed vaginal delivery attempt; | Identifier Code |
| 59622 | When a previous caesarean birth has been attempted, a caesarean delivery is the only option, and
postpartum care is limited to surgical procedures. |
Identifier Code |
Medical billing for OB-GYN ultrasound
For reporting ultrasound operations, adhering to all OBGYN medical billing and coding regulations for care during pregnancy is crucial. Each coded process should have corresponding pictures available for scrutiny, showing the relevant anatomy and pathology. CPT specifies neither the number of required photographs nor their storage method.
There may be a need for adjustments if more than one fetus is present or if different operations are being carried out on the same patient during the same visit. Getting a claim line denied for reporting a wrong modifier is possible. Below are several CPT codes used to describe various ultrasound recordings. Ensure that your clinic follows the correct reporting rules for each CPT code.
- 76801–76810: Mother and fetus assessment (Transabdominal Approach, By Trimester)
- 76811–76812: Superior and In-Depth Analysis of the Fetus’ Anatomy
- 76813–76814: Measuring of Fetal Nuchal Translucency
- 76818–76819: Prenatal Biophysical Profile
- 76815: Limited Investigation Using Trans-Abdominal Ultrasonography
- 59025: Fetal Non-Stress Examination
- 76816: Follow-Up Investigation Using Transabdominal Ultrasound 76817: Investigation of transvaginal ultrasound
Conclusion
When medically billing for maternity and obstetrical care, it’s crucial to consider all nine months of service provided. You must pay particular attention to the Global OB Package. The CPT rules must be strictly followed, with the correct diagnosis appended, the doctor’s documentation of prenatal, natal, and postnatal care, and any necessary changes to the modifier.