Nine months of care, often one claim
Routine obstetric care is usually billed as a single global package after delivery, covering months of visits. That makes obstetric revenue slow and lumpy, and it makes errors expensive: if the package is coded wrong, or if services that sit outside it are never billed, the practice loses money it cannot easily recover. Gynecology adds its own mix of preventive visits, office procedures, devices and surgery.
The global obstetric package
| Delivery | Global (antepartum, delivery, postpartum) | Delivery only | Delivery + postpartum |
|---|---|---|---|
| Vaginal delivery | 59400 | 59409 | 59410 |
| Cesarean delivery | 59510 | 59514 | 59515 |
| Vaginal birth after cesarean | 59610 | 59612 | 59614 |
| Attempted VBAC, cesarean delivery | 59618 | 59620 | 59622 |
The global codes include routine prenatal visits, the delivery and routine postpartum care. They are normally billed once, after delivery, with the date of delivery as the date of service. Some payers — especially Medicaid managed care plans — require notification at the first visit or have their own rules, so the package is set up at intake, not at delivery.
When care is split
Patients change practices, move or change insurance during pregnancy. When the same practice does not provide all the care under one plan, the global codes cannot be used. Antepartum care is billed separately — 59425 for four to six visits, 59426 for seven or more, and E/M codes for one to three — with delivery-only and postpartum-only codes for the rest. Tracking visit counts from the first appointment prevents guesswork later.
Outside the package
- Ultrasounds (76801–76817) are billed separately, by trimester, detail, number of gestations and approach (transabdominal or transvaginal 76817).
- Laboratory tests and screening are billed separately by whoever performs them.
- Problems unrelated to the pregnancy, and complications that require extra visits, can be billed with E/M codes when documented.
- Delivery-related procedures such as external cephalic version or postpartum tubal ligation are billed separately where the codes allow.
Gynecology: preventive visits, procedures and devices
Commercial plans cover well-woman visits under preventive codes (99384–99397) without cost-sharing in most cases, while Medicare covers a screening pelvic and breast exam (G0101) and Pap specimen collection (Q0091) on its own schedule. Office procedures — endometrial biopsy (58100), colposcopy (57452–57461), hysteroscopy (58555–58565) — have short global periods. Contraceptive implants and IUDs are billed as the insertion procedure plus the device by HCPCS code, and gynecologic surgery follows standard surgical global rules.