OB/GYN Medical Billing: Workflow, CPT Codes, and Challenges

• Streamline complex OB/GYN billing with proven workflows
• Avoid costly denials through accurate coding practices
• Stay compliant with ever-changing OB/GYN billing rules
• Maximize reimbursements by partnering with expert billers
• Simplify global maternity care billing for your practice

Obstetrics and Gynecology (OB/GYN) is among the top 10 most practiced medical specialties in the United States, with approximately 46,600 active OB/GYN practitioners nationwide. This specialty sees a high volume of patients across both outpatient and inpatient settings.

According to the American College of Obstetricians and Gynecologists (ACOG) report, up to 75% of professionals in this field suffer from physical and emotional exhaustion. This is due to the challenge of managing such a high patient volume alongside a complex medical billing process.

This blog will cover common issues, the OB/GYN medical billing workflow, and frequently used codes to help you overcome the OB/GYN billing challenges. Additionally, we will share OB/GYN coding best practices and provide an overview of leading billing service providers.

What is OB/GYN Medical Billing?

OB/GYN medical billing is the process of collecting payment for healthcare services provided in the field of obstetrics and gynecology. It involves translating medical procedures, such as routine checkups, prenatal visits, ultrasounds, deliveries, and gynecologic surgeries, into standardized codes used for insurance claims.

These codes include CPT for services, ICD-10 for diagnoses, and HCPCS for supplies and additional services. Once the services are coded, a claim is created and submitted to the patient’s insurance company for reimbursement.

Understanding the OB/GYN Billing Workflow: A Step-by-Step Breakdown

It is important to maintain an efficient workflow when performing OB/GYN medical billing. Go through the brief overview of the OB/GYN billing process steps below:

Step 1: Pre-Authorization and insurance eligibility verification

The front-desk staff must first verify if the patient has active insurance and whether it covers the planned services. Verification should always be completed before providing treatment to avoid future billing complications.

Step 2: Accurate Clinical Documentation

OB/GYN providers must document all services provided in the patient’s medical record with detailed clinical notes. Proper documentation is important for correct coding and ensures that all billable services are justified.

Step 3: Medical Coding

In this step, coders convert clinical documentation into standardized CPT, ICD-10, and HCPCS codes. OB/GYN coding may involve global maternity packages, surgical procedures, or office visits. All of these require precise code selection and use of proper modifiers to represent the services accurately.

Step 4: Charge Entry

After the services are coded, they are entered into the billing system while ensuring that patient demographics, provider details, and insurance information are correct. Next, the charges are re-checked for accuracy before claims are generated.

Step 5: Claim Submission

Once the claims are reviewed, they are submitted electronically to insurance companies or clearinghouses. Submitting clean claims improves the chances of timely payment and reduces delays in getting reimbursements.

Step 6: Payment Posting

When the insurance payments are received, they are posted to the patient’s account using ERAs or EOBs. Payment posting also includes reconciliation, adjustments, and identification of any underpaid or unpaid services.

Step 7: Denial Management

In case of a claim denial, billing staff identify the reason, correct errors if applicable, and resubmit the claim. Timely follow-up and appeals are necessary to recovering revenue and maintaining a healthy cash flow.

Step 8: Patient Billing and Collections

After insurance payments are posted, any remaining patient responsibility like co-pays, deductibles, or denied services is billed. Billers then create and send patient statements for these outstanding balances and follow up on collections to ensure timely payment.

What are the Common Billing Challenges in OB/GYN Practices?

According to recent statistics, nearly 10% of OB/GYN revenues are lost annually due to billing errors. Here are a few reasons why:

1. Coding Errors

Common errors include using outdated CPT codes. For example, confusing CPT 59400, which covers global maternity care, with CPT 59426, which applies only to delivery services. Such mistakes can lead to claim denials or reduced reimbursement.

2. Global Maternity Care Billing Complexities

The global maternity care package bundles prenatal visits, delivery (vaginal or cesarean), and postpartum care into a single payment. Providers often misinterpret what services are truly included in the bundle and mistakenly bill procedures separately. 

3. OB/GYN Billing Compliance Rule Updates

AMA and the CMS release updates to CPT, ICD-10, HCPCS codes along with new billing policies, documentation guidelines, and payer-specific requirements. These changes can create confusion and errors if practices fail to stay updated.

4. Insurance Verification & Pre-authorization Issues

The differences in insurance between Medicaid and private payers make OB/GYN billing complex. Other than that, procedures like hysterectomies and LEEPs require prior authorizations supported by proper clinical documentation.

5. High Initial Claim Denial Rates

Common reasons for denials include missing pre-authorizations, incorrect or outdated procedure codes, improper use of modifiers, and insufficient documentation. As a result, up to 17-20% of OB/GYN claims are initially rejected.

Healthcare consultants emphasize that specialized OB/GYN billing services can handle many of these issues. Outsourcing or consulting with experts in OB/GYN billing and coding has proven to reduce denials and expedite payments. (Go through our review of top medical billing companies that can help streamline your revenue cycle)

Common OB/GYN CPT Codes Every Obstetrician Must Know

The American Medical Association (AMA) updates the CPT code set for the OB/GYN specialty.

OB/GYN coding professionals must stay informed about these updates to maintain proper reimbursement. Below is a list of some of the most frequently used OB/GYN CPT codes list for 2025.

Category	CPT Code	Procedure Description
Routine Obstetric Care	59400	Global care: Prenatal, vaginal delivery & postpartum care
	59510	Global care: Cesarean delivery with prenatal & postpartum care
	59610	Vaginal delivery after previous C-section, includes prenatal & postpartum care
	59618	Repeat C-section after failed vaginal delivery attempt, includes prenatal & postpartum care
Diagnostic Procedures	57452	Colposcopy of cervix
	58100	Endometrial biopsy
	76801–76828	Obstetric ultrasounds
	76830	Transvaginal ultrasound
Surgical Procedures	58140	Myomectomy – Removal of 1 to 4 fibroids (≤ 240g) via abdominal incision
	58150	Total abdominal hysterectomy (uterus + cervix, possibly with tubes/ovaries)
	58570	Laparoscopic hysterectomy (uterus ≤ 250g, removal via vaginal or trocar ports)
	58700	Salpingectomy
	58956	Cancer surgery – Removal of uterus, cervix, ovaries, fallopian tubes & omentum
Infertility Treatment	58970	Egg retrieval for IVF (via ovarian drilling)
	58974	Embryo transfer in IVF (48–72 hours after fertilization)
	58976	GIFT – Direct transfer of gametes/zygote into fallopian tubes
Contraceptive Procedures	58300	IUD insertion
	58301	IUD removal
Reproductive Health	59812	D&C procedure for surgical removal of unexpelled miscarriage contents
	59840	Induced abortion – Suction curettage through cervix (1st trimester)

OB/GYN Billing Guidelines to Ensure Accurate Billing

OB/GYN practices face one of the highest insurance claim denial rates in healthcare, which is around 22.42%. This high claim denial rate leads to 11–12% of annual revenue loss in an OB/GYN practice.

Therefore, it’s essential to implement efficient billing practices to improve reimbursement and reduce revenue leakage.

Here are key tips to help ensure accurate OB/GYN medical billing:

1. Ensure Proper Documentation and Correct CPT Code Usage

Accurate OB/GYN documentation of each service, including diagnosis, procedures, and clinical notes is important for each code assignment. After that, apply correct OB/GYN CPT codes that accurately reflect the performed services. If an incorrect CPT code is assigned to a service, it can lead to claim denials or rejections.

2. Use Modifiers Correctly

The correct usage of modifiers is necessary as they offer significant additional information about the provided services. Common modifiers like 25 (separate E/M service), 51 (multiple procedures), 57 (decision for surgery), and 59 (distinct procedural service) help ensure accurate billing and reduce claim denials.

3. Track Global Obstetric Packages

Understand what services are bundled in global maternity codes as you cannot bill global services separately. You should identify the included services in these packages to avoid upcoding. Also, review payer policies and updates to stay informed about any changes to bundled services.

4. Stay Up‑to‑Date with CPT & ICD‑10 Revisions

As discussed earlier, the AMA’s editorial panel regularly updates OB/GYN coding guidelines. Make sure that you keep up with these changes to reduce the risk of errors. You can do that by arranging regular coding workshops and establishing a comprehensive auditing process.

5. Consider Outsourcing to OB/GYN Billing Companies

Managing an in-house billing team is not easy when you are working in a complex medical speciality like OB/GYN. Therefore, it’s always a good idea to outsource OB/GYN medical billing services. Along with following the best OB/GYN medical coding tips, they expertly handle complex codes, claim submissions, and denial management.

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