Your Ultimate Guide to Accurate Coding, Faster Payments & Fewer Denials
⭐ Introduction: The Hidden Complexity of OB/GYN Billing
OB/GYN billing is one of the most complex areas in medical billing — involving global obstetric packages, evaluation & management (E/M) services, surgical procedures, ultrasounds, contraceptive management, and postpartum care. One missed modifier or incorrect global period rule can cause thousands in lost revenue.
In 2025, payer rules, CPT guidelines, and OB package requirements have become stricter, leaving many practices overwhelmed with denials.
This 2025 Complete Coding Playbook makes OB/GYN billing simpler, clearer, and more profitable — and positions Solubillix as your trusted billing partner to eliminate mistakes and maximize reimbursements.
Understanding the OB/GYN Global Obstetric Package
The Global OB Package bundles multiple services into one CPT code. This is one of the biggest areas where practices lose money due to misunderstanding what is and is not included.
✔ Global OB Package Includes
- Routine prenatal visits
- Delivery (vaginal or C-section)
- Postpartum care (6 weeks)
✔ Global OB Package Does NOT Include
These MUST be billed separately for full reimbursement:
- Ultrasounds
- Maternal-Fetal Medicine consults
- Non-stress tests (NST)
- Amniocentesis
- Complicated prenatal visits outside routine schedule
- Cerclage
- Ectopic pregnancy management
- High-risk pregnancy care
- Labs & vaccines
Most practices lose revenue by failing to carve out services from the global package.
Solubillix ensures all carve-out services are billed correctly — increasing OB revenue by 25–40%.
OB CPT Codes (Updated)
Global OB Package Codes
| CPT Code | Description |
| 59400 | Routine prenatal + vaginal delivery + postpartum |
| 59510 | Routine prenatal + C-section + postpartum |
| 59610 | VBAC delivery + routine prenatal + postpartum |
| 59618 | C-section delivery after attempted VBAC + postpartum |
Delivery-Only Codes
Use these if another provider performed prenatal care:
- 59409 – Vaginal delivery only
- 59514 – C-section only
- 59612 – VBAC delivery only
- 59620 – C-section after VBAC attempt
Antepartum-Only Codes
- 59425 – 4–6 routine OB visits
- 59426 – 7+ routine OB visits
Postpartum Care Only
- 59430 – Postpartum only (when Solubillix sees many practices forget this code)
GYN Coding (High-Value Codes)
E/M Visits
- 99213, 99214, 99215 — Common for GYN follow-ups
- Modifier 25 is critical when performing a procedure in addition to an office visit.
Common Procedures
| CPT | Description |
| 57454 | Colposcopy with biopsy |
| 57522 | LEEP procedure |
| 58301 | IUD removal |
| 58300 | IUD insertion |
| 58558 | Hysteroscopy with biopsy |
| 58661 | Laparoscopy for tubal ligation |
| 81025 | Pregnancy test |
Modifier Tips
- Modifier 25 → E/M + procedure same day
- Modifier 51 → Multiple procedures
- Modifier 59 → Distinct service (avoids bundling errors)
Correct modifier use can increase approved payments by 20–30%.
OB/GYN Ultrasound Billing Rules
Ultrasounds are not included in the global OB package.
Common OB Ultrasound CPT Codes:
| CPT | Description |
| 76801 | First-trimester OB ultrasound |
| 76805 | Second/third-trimester OB ultrasound |
| 76813 | Nuchal translucency |
| 76817 | Transvaginal ultrasound |
| 76816 | Follow-up ultrasound |
Key Billing Notes:
- Always document medical necessity
- Some payers require ICD-10 pregnancy complication codes
- Frequency limits apply (varies by payer)
Solubillix stays updated on payer rules to prevent ultrasound denials.
OB/GYN ICD-10 Coding Essentials
Pregnancy-Related ICD-10 Codes (Most Used)
- Z34.0–Z34.9 → Normal pregnancy
- O09.0–O09.93 → High-risk pregnancy
- O20.0 → Threatened abortion
- O26.9 → Pregnancy-related conditions
- O30.0–O30.93 → Multiple gestation
- O36.80X0 → Fetal problems, unspecified
Gynecology ICD-10 Codes
- N92.0–N92.6 → Abnormal uterine bleeding
- N80.0–N80.9 → Endometriosis
- N70-N77 → Pelvic inflammatory diseases
- N84.0 → Endometrial polyp
Accurate ICD-10 pairing reduces the risk of denials by over 50%.
Denial Prevention Tips for OB/GYN Billing
🔒 The most common OB/GYN denial reasons:
- Missing or incorrect global package billing
- Incorrect ultrasound frequency
- No modifier 25 on same-day E/M + procedure
- Wrong gestational age coding
- Bundling issues with IUD procedures
- Missing operative notes
- Delivery-only billed incorrectly
✔ How Solubillix Prevents These Denials:
- Real-time claim audits
- Pre-submission coding accuracy check
- Monthly denial trend analysis
- Provider documentation training
- Insurance rule updates monitored daily
OB/GYN Billing Workflow That Improves Revenue
A high-performing OB/GYN practice requires a structured, optimized billing workflow:
- Eligibility & Benefits Verification
- OB Package Setup in EHR
- Prenatal Visit Tracking
- Non-Global Services Carved Out
- Delivery Claim Accuracy Check
- ICD-10 High-Risk Coding
- Clean Claim Submission
- Payment Posting & Reconciliation
- Aggressive Denial Management
- Monthly Provider Revenue Reports
This is the exact workflow Solubillix uses to improve reimbursement speed by 35–60%.
Why OB/GYN Practices Choose Solubillix
OB/GYN physicians face:
- Constant coding updates
- Heavy documentation requirements
- Frequent denials
- Insurance rule changes
- Complex global billing policies
Solubillix solves these challenges with:
✔ OB/GYN-Certified Coders
✔ 100% Compliance Monitoring
✔ Real-Time Claim Scrubbing
✔ 24–48 Hour Claim Submission
✔ Monthly Revenue Optimization Reports
✔ Transparent Communication & Zero Hidden Fees
Our clients see:
- 30–60% increase in revenue
- 70% reduction in A/R over 90 days
- Fewer denials and faster payments
Ready to Simplify OB/GYN Billing and Increase Your Revenue?
Solubillix specializes in OB/GYN billing, coding, and revenue cycle management with proven results.
👉 Book a Free OB/GYN Billing Consultation
👉 Get a Complimentary Revenue Audit
👉 See How Much Revenue You’re Losing Each Month
Let Solubillix handle your billing so you can focus on patient care — not paperwork.
