CPT Codes for OBGYN Procedures & Coding Guidelines 2024

How can OBGYNs master complex billing processes when their primary focus is improving women’s health? OBGYN is a rewarding specialty, but the workload is quite intense. As a result, OBGYNs don’t pay much attention to the administrative side of their work. This leads to poor billing practices, including inaccurate coding.

Every medical professional knows that coding for Obstetrics and Gynecology (OBGYN or OB/GYN) is highly complex because the specialty involves multiple components of patient care. 

Moreover, annual coding revisions further increase the difficulty. Unfortunately, there is no other solution! You must be familiar with popular OBGYN CPT codes to receive proper reimbursements from insurance providers.

Common OBGYN CPT Codes

The American Medical Association (AMA) also maintains the code set for this specialty. Their editorial panel is responsible for revising and modifying the CPT codes for OBGYN. However, these annual revisions are a challenge for the administrative side of obstetrics and gynecology, requiring them to work extra hours to code all the procedures accurately.

As an OBGYN coding expert, you should know the necessary codes and stay updated on their annual revisions. Here are some of the most commonly used CPT codes for OBGYN in 2024.

OBGYN CPT Codes for Routine Obstetric Care

CPT Code 59400 – Prenatal Care, Normal Delivery & Postpartum Care

The 59400 CPT code is one of the popular global obstetric care codes. This code specifies all the care services throughout a patient’s pregnancy, including antepartum care, vaginal birth, and postpartum care. These care services typically include the patient’s admission to the hospital, labor induction, vaginal delivery of the baby, and both inpatient and outpatient care after the birth.

Healthcare providers use this code to bill all the care services that begin around 8 to 10 weeks into pregnancy and end after 6 weeks of delivery.

CPT Code 59510 – Prenatal Care, Cesarean Delivery & Postpartum Care

The 59510 code is similar to OBGYN CPT code 59400, addressing all prenatal and postpartum care services. However, there is one difference. Healthcare providers use this code when cesarean delivery is involved in the comprehensive obstetric care package.

CPT Code 59610 – Prenatal Care, Normal Delivery after Previous Cesarean Birth, Postpartum Care

This medical procedural code also falls under routine obstetric care. OBGYNs use the 59610 CPT code to bill all the antepartum, delivery, and postpartum care services they have provided to a patient. The unique part of this code is that it reports that the patient who previously had a cesarean birth delivered the baby naturally this time.

CPT Code 59618 – Prenatal Care, Cesarean Delivery after Attempted Normal Birth, Postpartum Care

The 59618 CPT code also addresses a comprehensive routine obstetric care package. Healthcare providers use this code to specify all the care services they have provided to a pregnant patient, from hospital admission to postpartum care.

However, OBGYN CPT code 59618 is specially used when repeated cesarean delivery is involved in obstetric care. In simple terms, it means that the patient was unable to deliver the baby naturally after a previous cesarean birth. In the end, the doctor had to perform a cesarean section again.

OBGYN CPT Codes for Diagnostic Procedures

CPT Code 57452 – Endoscopy Procedure to Detect & Prevent Cervical Cancer

OBGYN CPT code 57452 falls under the endoscopy procedures. Gynecologists use this code to notify the insurer that they have used a colposcope to analyze their patient’s cervix. The primary goal of this procedure is to detect and treat precancerous conditions.

CPT Code 58100 – Endometrial Biopsy

This OBGYN CPT code is one of the popular diagnostic procedures. Healthcare professionals use the 58100 CPT code to claim reimbursement for an endometrial biopsy.

In this procedure, they obtain a sample from a woman’s uterus lining for examination without stretching the cervical opening. It helps them identify any potential issues, such as fertility problems and abnormal uterine bleeding.

CPT Code 76801-76828 – Obstetric Pelvic Ultrasound Procedures

These 19 OBGYN CPT codes, ranging from 76801 to 76828, address ultrasound examinations in the pelvic region of a pregnant woman. Healthcare providers use one of these codes to bill a specific type of imaging procedure they have performed to monitor the fetus and the mother at a specific period. For example:

• CPT code 76801 is used to bill the ultrasound performed in the first trimester.
• CPT code 76802 is used to specify a transabdominal ultrasound in the first trimester. In this procedure, doctors monitor gestational sacs.

Similarly, other obstetrical ultrasound CPT codes address different situations.

CPT Code 76830 – Transvaginal Ultrasound

This diagnostic OBGYN CPT code highlights a transvaginal ultrasound. Healthcare providers use the 76830 CPT code to charge an insurance company for an imaging test. They perform this test to analyze a woman’s reproductive organs, including the uterus, ovaries, fallopian tubes, cervix, and pelvic area.

OBGYN CPT Codes for Surgical Procedures

CPT Code 58140 – Myomectomy (Excision of Non-Cancerous Tumors)

This OBGYN CPT code refers to a myomectomy procedure. Physicians use the 58140 code to notify a payer that they have excised 1 to 4 fibroid tumors, totaling up to 240 grams or less, from a patient’s uterus. This surgical process is performed via abdomen incision.

CPT Code 58150 – Hysterectomy

This OBGYN CPT code points to one of the hysterectomy procedures. Code 58150 allows healthcare providers to claim payment for removing a patient’s womb (uterus and cervix) through an abdominal cut. During the procedure, OBGYNs may or may not completely or partially remove the fallopian tubes and ovaries.

CPT Code 58570 – Laparoscopic/Hysterectomy Procedure

The 58570 CPT code refers to one of the laparoscopic/hysterectomy procedures on the body of the uterus (corpus uteri). In simple words, it addresses a surgical procedure to remove a normal-sized (250 gm) uterus and cervix. 

In this process, an OBGYN first uses a laparoscope to cut all uterine and cervical connections and then removes a patient’s womb via the vaginal canal or trocar ports.

CPT Code 58700 – Fallopian Tube Excision (Salpingectomy)

The 58700 CPT code for OBGYN specifies an excision procedure called salpingectomy. OBGYNs use it to notify payers that they have surgically removed one or both fallopian tubes completely or partially. They perform this excision procedure to reduce the chances of ovarian cancer.  

CPT Code 58956 – Ovary Excision Procedure

This CPT code for OBGYN procedures highlights an ovary excision due to cancer. OBGYNs use this code to specify that they have performed an abdominal surgery to remove the uterus, cervix, fallopian tubes, ovaries, and the entire omentum.

OBGYN CPT Codes for Infertility Treatment

CPT Code 58970 – In Vitro Fertilization (Egg Retrieval)

The 58970 is one of the most popular CPT codes for treating infertility. It indicates an ovarian drilling process to retrieve an egg. In an IVF procedure, an OBGYN uses a needle to make several holes in a patient’s ovary through the vaginal wall. The healthcare provider then removes the egg and fertilizes it in the lab.

CPT Code 58974 – In Vitro Fertilization (Embryo Transfer)

This OBGYN CPT code also addresses one of the IVF procedures. OBGYNs use the 58974 code to indicate that they have transferred fertilized eggs (embryos) in a patient’s uterus after keeping them in the lab for 48 to 72 hours.

CPT Code 58976 – Gamete Intrafallopian Transfer (GIFT)

The 58976 CPT code also highlights a part of the In Vitro Fertilization (IVF) procedure. This code specifies a gamete intrafallopian transfer (GIFT) process where the doctor directly injects eggs and sperm (gametes) or a fertilized egg (zygote) into the fallopian tube via a catheter (a thin, flexible tube).

OBGYN CPT Codes for Contraceptive Devices/Procedures

CPT Code 58300 – Insertion of Intrauterine Device (IUD)

This OBGYN CPT code falls under the corpus uteri procedures category. Gynecologists typically use it to claim reimbursement for a long-acting, reversible contraception (LARC). In short, they use this code to indicate that they have placed an IUD (a t-shaped birth control device) in a patient’s uterine cavity.

CPT Code 58301 – Removal of Intrauterine Device (IUD)

This CPT code is the opposite of 58300. Gynecologists use the 58301 CPT code to specify that they have removed an IUD from a patient’s uterine cavity.

OBGYN CPT Codes for Reproductive Health Procedures

CPT Code 59812 – Surgical Removal of Unexpelled Miscarriage Contents (D&C)

The 59812 is one of the most commonly used OBGYN CPT codes. Doctors use it to notify a payer about a dilation and curettage (D&C) procedure performed vaginally on a patient. This procedure is necessary to remove all the pregnancy contents that were not expelled during a miscarriage.

CPT Code 59840 – Induced Abortion

The 59840 CPT code addresses one of the abortion procedures performed due to elective or health reasons. Doctors use this OBGYN CPT code to notify a payer about the deliberate termination of a patient’s pregnancy. 

They induce this abortion by dilating the cervix and removing the embryo via a suction curette through the vagina. OBGYNs typically perform this procedure in the first trimester.

OBGYN Coding Guidelines

Did you know that OBGYN is one of the most stressful medical specialties? According to the American College of Obstetricians and Gynecologists (ACOG) report, up to 75% of professionals in this field experience physical and emotional exhaustion. Therefore, it is no wonder that OBGYNs handle the billing process, including coding, less meticulously, leading to high denial rates of up to 22.42%.

While we cannot address all the billing challenges, we can simplify the leading problem of this specialty – the complex coding procedure. Follow our OBGYN coding guidelines to satisfy different payers.

Document Every Procedure/Service

Don’t lose important details due to your heavy workload. Document every procedure and service provided to patients along with their medical history to avoid coding mistakes. 

Your OBGYN CPT codes should accurately reflect the performed services so insurers can distinguish a high-risk obstetrical procedure from a routine gynecological treatment.

Recognize Global Care Packages

You cannot bill global services separately. Global maternity packages include all the services provided throughout a patient’s pregnancy, including antepartum, delivery, and postpartum care. You should identify the included services in these packages to avoid upcoding.

Use Accurate Modifiers

Modifiers are essential in OBGYN as they offer significant additional information about the provided services. Some common modifiers used in this specialty include:

• Modifier 25: Specifies separately identifiable E/M service.
• Modifier 51: Highlights multiple procedures in the same session.
• Modifier 57: Reports an E/M service where an OBGYN decided to perform surgery a day before a major operation or on the same day.

Frequently Update Coding Knowledge

As mentioned earlier, the AMA’s editorial panel regularly updates OBGYN coding guidelines. 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.

Use Appropriate Diagnostic Codes (ICD-10)

Besides CPT codes, you should also be familiar with the popular diagnostic codes for OBGYN. These codes notify the payers about a patient’s medical condition and justify the need for provided service. Keep in mind that inaccurate or missing diagnosis codes can lead to claim denials and payment delays.

Seek Help from a Coding Expert

Expecting coding proficiency from an average OBGYN is unreasonable. If you work in this specialty, you might already know that medical billing is a full-time job in itself. Therefore, you should have a dedicated team to handle every financial task. But if you don’t, you can always seek a professional coder. 

Many OBGYN Billing Services include affordable medical coding, allowing you to dedicate more time to your patients. So, choose one of the cost-effective options and reduce your claim denials.

Bottom Line

Coding is always a challenging part of a billing process, regardless of your specialty. You can only receive complete payments for your services via accurate coding. However, frequent coding revisions, complex requirements, and varying regulations can stand in your way. However, you can overcome these challenges by maintaining proper documentation and staying updated with annual revisions. We have highlighted the most commonly used OBGYN CPT codes in 2024 so you can accurately code all the services. Get paid for what you deserve with accurate coding!