The OB/GYN Billing Workflow
OB/GYN billing requires two parallel workflows: one for obstetric care (global package with delayed billing) and one for gynecologic services (per-encounter billing with standard timelines). The practice must manage both simultaneously, often for the same patient who receives prenatal care and has a gynecologic issue addressed during pregnancy. Keeping these billing streams correctly separated is the primary operational challenge.
Step 1: Insurance Verification and OB Notification
For new OB patients, verify maternity benefits at the first prenatal visit. Key items: Is maternity covered? What is the global OB reimbursement rate? Is there a separate maternity deductible? Does the plan require notification of pregnancy (not authorization, but notification)? Some plans require the practice to submit an OB notification form that establishes the expected delivery date and the global billing arrangement.
For gynecologic patients, verify standard benefits including coverage for preventive exams, procedure authorization requirements, and specialist copay amounts. Most commercial plans cover annual well-woman exams at 100% with no cost-sharing under ACA preventive care mandates.
Step 2: Antepartum Care Tracking
Track each antepartum visit on a log that records the date of service, gestational age, and services provided. This log serves three purposes: it documents the number of antepartum visits for global package billing, it identifies visits that include non-routine services billable outside the global package, and it supports the antepartum-only code if the patient transfers care.
Non-routine antepartum services that are billed separately include: evaluation and management of pregnancy complications (hyperemesis, preterm labor, gestational diabetes), non-stress tests (59025), and additional ultrasounds beyond the standard protocol. Each of these requires a complication-specific diagnosis code to distinguish it from routine antepartum care included in the global package.
Step 3: Delivery Billing
The global OB claim is submitted after delivery. The claim includes the global OB code (59400, 59510, or 59610), the delivery date, and the primary delivery diagnosis (O80 for uncomplicated vaginal, O82 for cesarean). If complications occurred during delivery, additional procedure codes may apply: episiotomy repair (59300), manual removal of placenta (59414), or repair of cervical laceration (59160).
Submit the global OB claim within 7 days of delivery. Delays in submission push the revenue for months of antepartum care further into the future and extend AR days artificially. The delivery admission date, not the first antepartum visit, is the date of service on the global claim.
Step 4: Gynecologic Service Billing
Gynecologic visits and procedures follow standard per-encounter billing. Submit claims within 48 hours. For well-woman visits that also address a medical problem, bill the preventive code and the E/M code with modifier 25 on the same claim. The preventive component uses a Z-code (Z01.411 for routine gyn exam) and the problem component uses the specific condition code.
Step 5: Postpartum Follow-Up
The postpartum visit at 4 to 6 weeks is included in the global OB package and is not separately billable. However, if the patient presents with a postpartum complication (wound infection, postpartum depression, mastitis), the evaluation and management of the complication can be billed separately with modifier 24 (unrelated E/M during post-op period) and the specific complication diagnosis.
Step 6: Patient Responsibility Management
OB patients accumulate significant patient responsibility over the pregnancy. The global OB fee may be $2,000 to $4,000 depending on the payer, and the patient deductible and coinsurance can result in $1,000 to $3,000 in out-of-pocket costs. Many practices collect a portion of the estimated patient responsibility at each antepartum visit rather than billing the full amount after delivery. This approach improves collection rates and reduces post-delivery balance surprises.