It seems the world of medical billing gets more complicated every year, doesn’t it? The intricacies of coding can be particularly complex — especially in the obstetrics and gynecology field.
While OB/GYN medical billing may be a lot to manage, having a solid understanding of Current Procedural Terminology (CPT) codes influences one critical piece of your practice: getting paid.
Unfortunately, changes to these codes and their interpretation can be challenging to track. Having an OB/GYN billing cheat sheet (like the one below) and a solid medical billing software partnership can help.
What Is a CPT Code?
A CPT code, or Current Procedural Terminology code, is a number that corresponds with a particular medical service or procedure. CPT codes are a standardized system and a way for payers and insurers to speak the same language about medical services. Providers submit claims with these CPT codes to receive payment from insurers.
In general, OB billing codes range from 56405 to 59899, but you may use other codes outside that range for routine gynecologic care and well-woman visits.
OB/GYN Coding Cheat Sheet
Keeping track of OB/GYN CPT codes and billing best practices is far from easy. We’ve put together this cheat sheet with a few basics for OB/GYN billing. You can download the full cheat sheet with CPT codes here or check out a short preview below.
OB Billing and Coding Best Practices
OB coding can certainly cause some headaches, but remembering a few key essentials will help you with more accurate claims:
- Make sure you understand the payer’s billing guidelines for deliveries, antepartum care and global codes. Every plan is different. For example, Medicaid HMO plans require you to bill for deliveries with non-standard codes.
- Create an “OB contract” for patients to pay their portion of the delivery claim before delivery. Patients will have a lot of medical bills from the delivery experience. They’ll have a better sense of security and overall experience with price transparency, up-front estimates and the option to make payments before delivery.
- Use global codes for maternity care. Avoid billing separately for services already included in these codes.
- Don’t forget to use separate E/M codes when appropriate. You can use these codes for services that aren’t related to maternity care
Get more best practices in our full OB/GYN Coding Cheat Sheet.
Global Codes for OB/GYN Billing
You’ll notice that we’ve outlined some maternity care global codes in this OB/GYN billing cheat sheet. You can use these codes when the same physician or physician group provides all maternity services for a patient.
OB global codes include 59400, 59510, 59610 and 59618. These include all care from antepartum through delivery and postpartum care.
- 59400 – Routine obstetric care for vaginal delivery (with or without episiotomy and/or forceps), including antepartum and postpartum care.
- 59510 – Routine obstetric care for cesarean section delivery, including antepartum and postpartum care.
- 59610 – Routine obstetric care for vaginal delivery (with or without episiotomy and/or forceps) after cesarean delivery, including antepartum and postpartum care.
- 59618 – Routine obstetric care for cesarean delivery following attempted vaginal delivery after previous cesarean delivery, including antepartum and postpartum care.
It’s important to note when you use a global code, you can’t bill separate evaluation and management (E/M) codes for individual parts of maternity care. However, you can bill separately if the mother’s insurance coverage changes during the pregnancy or if another physician cares for the mother before you complete all the services in the global code.
You can also separately bill the initial visit to confirm pregnancy.
You can bill E/M codes if the mother seeks care for a problem not related to her pregnancy, such as treatment for a yeast infection or a postpartum discussion about birth control. You will also bill separate codes for most lab tests you do during the pregnancy.
Gynecology Coding Best Practices
If you’re working on the ‘GYN’ side of OB/GYN, there are other best practices you’ll need to keep in mind.
A hysterectomy is surgery to remove the uterus. Although this procedure may sound relatively straightforward, there are some unique coding and billing best practices to keep in mind:
- The approach to the surgery will determine the CPT code. There are three main approaches: abdominal, vaginal and laparoscopic.
- The weight of the uterus can also influence which CPT code you should use.
- The extent of the surgery (how much of the uterus is removed) may influence which CPT code you should use.
- Some CPT codes factor in additional services or procedures with the hysterectomy.
- Abdominal hysterectomy codes range between 58150 and 58210.
- Vaginal hysterectomy codes range between 58260 and 58291.
- Laparoscopic hysterectomy codes range between 58541 and 58573.
Well-woman exams are yearly check-ups women have with their OB/GYN. These appointments can include a general health screening as well as cervical cancer screening.
It’s important to remember that you’ll code well-woman exams based on two factors: the age of the patient and whether they are a new or returning patient. New patient codes range from 99385-99387 and existing patient codes range from 99395-99397.
What About Modifiers?
OB/GYN CPT codes often include modifiers on the end. Modifiers are two-digit codes that show you’ve somehow altered the service in the original five-digit CPT code. For example, if a woman delivers twins, you may use the “22” modifier to indicate additional or increased services. For a full list of common OB/GYN modifiers, download our coding cheat sheet.
Find a Partner Who Can Modernize Your OB/GYN Billing Process
Efficient and accurate coding is one piece of healthy revenue cycle management and crucial to the success of your OB/GYN practice. So, why waste resources on an outdated, clunky billing process?
With Gentem’s AI-powered revenue cycle management (RCM) platform, you can:
- Easily manage all your OB patients in one spot. This helps you track all your patients and the services you provide, so you’re not leaving money on the table.
- Catch high-deductible patients so you can optimize when to bill your claim.
- Streamline OB/GYN patient estimates, so you can increase up-front payments and improve the patient experience.
Whether you need complete RCM support or state-of-the-art software to boost your medical billing team, we have you covered. Our platform has helped OB/GYN practices achieve record collections, allowing them to expand staff and care for more patients.
Learn more about our powerful RCM and billing tools by booking a demo today.
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