Billing for maternity care is complex and many physicians rely on professional obstetrics and gynecology medical billing services.

1. Obstetrics and Gynecology Medical Billing – Some Key Points
Billing for maternity care is complex and many physicians rely on
professional obstetrics and gynecology medical billing services.
Outsource Strategies International
8596 E. 101st Street, Suite H
Tulsa, OK 74133

2. www.outsourcestrategies.com Phone: 1-800-670-2809
When treating pregnant women, obstetricians and gynecologists have to deal with many
fetal and anatomical considerations and unexpected eventualities. All this makes obstetrics
and gynecology medical billing quite challenging. Here are some key points to note to
billing for this specialty.
 Reporting confirmation of pregnancy visit: One common question is whether to
report the initial visit to confirm a pregnancy as an E/M visit separately from the
global OB package. To code this correctly, it should be determined whether:
- if the patient is there for a confirmation of pregnancy or if the pregnancy has
already been confirmed, and
- if the OB record has been initiated
If the patient has symptoms of pregnancy or has had a positive home pregnancy test and is
visiting to confirm pregnancy, this encounter can be reported using appropriate level E/M
services code. On the other hand, if OB record is initiated at this visit, then the visit cannot
be billed separately and is part of the global OB package. However, the decision on initiating
global OB care would depend on the clinical circumstances, the physicians’ medical
evaluation, and insurance reimbursement policies. Under ICD-10-CM, the diagnostic coding
options are:
Z32.00 Encounter for pregnancy test, result unknown
Z32.02 Encounter for pregnancy test, result negative
Z32.01 Encounter for pregnancy test, result positive
 Billing for normal and ‘complicated’ pregnancy: The following CPT codes are
used to report a normal, uncomplicated pregnancy:
- 59400 Routine obstetric care including antepartum care, vaginal delivery (with or
without episiotomy, and/or forceps) and postpartum care
- 59510 Routine obstetric care including antepartum care, cesarean delivery, and
postpartum care
- 59610 Routine obstetric care including antepartum care, vaginal delivery (with or
without episiotomy, and/or forceps) and postpartum care, after previous
cesarean delivery

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- 59618 Routine obstetric care including antepartum care, cesarean delivery, and
postpartum care, following attempted vaginal delivery after previous cesarean
delivery
Delivery, antepartum care, and postpartum care should be reported separately using
dedicated CPT codes if the physician does not perform all services described by the global
codes.
 Global OB: The global obstetric (OB) code should be billed whenever one physician
or physicians of the same group provide all components of the patient’s care. This
includes 4 or more antepartum visits, delivery and postpartum care. The number of
antepartum visits may vary from patient to patient, but if global ob care is provided,
the global OB code should be used to bill all pregnancy related visits (apart from
inpatient hospital visits for complications of pregnancy). Individual E/M codes should
not be used to bill pregnancy related E/M visits.
Lab tests (excluding dipstick urinalysis), diagnostic ultrasound, amniocentesis,
cordocentesis, chorionic villus sampling, fetal stress test, and fetal non-stress test
are not considered part of global maternity services and should be billed separately.
 Broken global: This happens when the patient changes insurance during the
pregnancy, but continues to see the same physician. Different insurance providers
have different policies and procedures as well as antepartum codes for single and
multiple births. So when a patient switches insurance, the biller should ensure
adherence to payers’ individual rules. Generally, insurers will pay only for that
specific portion of care for which they are responsible.
However, this rule would not apply if the patient delivers late or has several worried-
well visits from the point where she changed her insurance provider. In this case, the
requirements of the new insurance might be met and global billing may be justified.
With all these complexities, it’s hardly surprising that many medical facilities are relying on
obstetrics and gynecology medical billing and coding services.
Experienced medical billing and coding companies are well aware of the rules of
different payers and can submit claims to ensure maximum reimbursement.