OBGYN Billing Services
The complexity of prenatal care, gynaecological procedures, and delivery services can make it overwhelming to manage billing in an OBGYN practice. Coding mistakes or submission of claims can result in delayed payments, rejected claims, and extreme stress on your employees.
It is at that point that professional OBGYN billing services can be beneficial, as aims are processed properly with professional assistance, insurance requirements are addressed, and the process is timely.
This can guarantee that your practice gets payments on time and minimizes the burden of administration. With outsourcing billing, your staff will be able to concentrate on the most important things, which is to give excellent care to patients. Proven billing systems simplify the billing process, reduce errors and provide your practice with the financial stability it needs.
OB/GYN Payer Rules We Manage
OB/GYN claims change when the patient’s coverage changes, when a pregnancy becomes high-risk, and with each state’s Medicaid rules. These are the payer rules our medical billing team handles beyond the codes:
Medicaid maternity billing
What it means: Some state Medicaid programs don’t pay global maternity codes and expect antepartum visits, delivery and postpartum care billed separately. Many also cover pregnant patients under presumptive eligibility before full enrollment.
How we handle it: We follow each state’s maternity billing rules and track presumptive eligibility until the patient’s full coverage starts.
Insurance changes during pregnancy
What it means: If the patient changes plans or practices before delivery, the global code can’t be used. Antepartum visits are billed to each plan by visit count (59425 or 59426), and the delivery goes to the plan in effect that day.
How we handle it: We track coverage at every visit and split the maternity billing when it changes.
High-risk pregnancy visits
What it means: Visits for complications such as preeclampsia or gestational diabetes, beyond routine prenatal care, can be billed outside the global package with the right pregnancy diagnosis codes.
How we handle it: We separate routine prenatal visits from complication visits and link the complication diagnosis to each extra visit.
Multiple births
What it means: Payers differ on billing twins: a second vaginal delivery is often billed with modifier 51 or 59, and a cesarean for twins may be billed once with modifier 22.
How we handle it: We follow each payer’s policy for multiple births and send the operative note when extra work is billed.
Medicaid sterilization consent
What it means: Medicaid pays for tubal ligation only with the federal consent form signed at least 30 days and no more than 180 days before surgery, by a patient 21 or older.
How we handle it: We check the consent form dates and signatures before surgery is scheduled, not after the claim is denied.
Extended postpartum coverage
What it means: Most states now cover Medicaid patients for 12 months after delivery, so postpartum visits and depression screening later in the year can still be billed to Medicaid.
How we handle it: We check postpartum eligibility dates and bill follow-up care to Medicaid when the patient is still covered.
A Common OB/GYN Denial and How We Fix It
Example: a tubal ligation denied for the consent form
The denial. A Medicaid patient has a tubal ligation after a cesarean, and the claim is denied because the federal sterilization consent form was signed 20 days before surgery.
How we fix it:
- Check the form. We review the signature dates, the patient’s age and every required field.
- Check the exceptions. The waiting period can be 72 hours for premature delivery or emergency abdominal surgery when the form was signed at least 30 days before the expected delivery date.
- Correct or resubmit. If an exception applies, we resubmit with the form and the records that support it. If not, the sterilization can’t be billed to Medicaid.
- Prevent the next one. We check consent dates at the prenatal visit where sterilization is planned.
Example: an obstetric ultrasound denied for the diagnosis
The denial. A follow-up ultrasound after the first trimester (76816) comes back with CARC 11 (diagnosis inconsistent with the procedure) because it was billed with a routine supervision-of-pregnancy diagnosis.
How we fix it: we check the report for the reason the follow-up scan was needed, such as fetal growth restriction, and correct the claim with that diagnosis and the Z3A code for weeks of gestation. Our denial management team then adds a diagnosis check to every ultrasound claim.
Why Choose OBGYN Billing Services?
Enhanced Accuracy in Coding and Claims
We guarantee accurate coding of prenatal care services, procedures and delivery services. Our billing team is very efficient and reduces errors and avoids denials, and ensures that all the services are billed correctly. More revenue flow and healthy financial flow are achieved through our accuracy in your OBGYN practice.
Improved Reimbursement and Delays
We file clean claims in good time and adhere to payer regulations in order to prevent delays. We understand how to make insurance reimbursements faster and ensure steady cash flow. Through us, your practice does not experience any financial disruptions and rather is kept on track to provide high-quality patient care.
Knowledge of the Regulations of OBGYN
We are informed about OBGYN-specific regulations, bundle codes and payer policies. The wisdom of our knowledge saves your practice against compliance risks and guarantees adequate reimbursement of routine visits and complicated obstetric surgeries. Your billing remains correct and in compliance with us.
Reduced Denial Rates and A/R Management
We go ahead to check claims, denials and ageing accounts. The regular follow-up by us minimises backlogs and maximises successfully paid claims. Because of this, your practice is in a better position financially and has no more administrative hassles.
More Time for Patient Care
We do the billing because your staff can do all the work on the patient. Our services save on paperwork, coding problems, and insurance nightmares. Your providers, with our assistance, take more time on consultations, prenatal monitoring, and procedures.
Scalable and Cost-Effective Solutions
Our billing solutions are easy to use and do not require additional employees or software to be effective. We match the growth of your practice, be it an addition of providers or an increase in location. Under our flexible solution, we increase revenue but do not need to increase overhead.
OB/GYN Codes for Global Obstetric Care, Ultrasound and Contraception
Obstetric billing is built around global maternity packages, and gynecology adds procedures, contraception and preventive care.
| Service | Codes and rules | What we check |
|---|---|---|
| Global obstetric care | 59400 vaginal delivery, 59510 cesarean, 59610 and 59618 after a previous cesarean, each covering antepartum, delivery and postpartum care | Global codes are used only when the same practice provides all three parts of care |
| Partial care | 59425 (4–6 antepartum visits) and 59426 (7 or more); delivery-only codes; 59430 postpartum only | Partial codes are used when the patient transfers in or out |
| Obstetric ultrasound | 76801 and 76802 first trimester; 76805 and 76810 after the first trimester; 76811 detailed anatomy; 76815 limited; 76817 transvaginal | Gestational age and the report support the code |
| Pregnancy diagnoses | O-codes for the pregnancy and Z3A codes for weeks of gestation | Z3A matches the gestational age on the date of service |
| Contraception | 58300 IUD insertion with the device code (for example J7297 or J7298); 11981 implant insertion with J7307 | Device codes and lot numbers are recorded |
| Preventive gynecology | 99384–99397 preventive visits; G0101 and Q0091 Medicare pelvic exam and Pap collection | Medicare frequency limits are checked |
OBGYN Billing FAQs
What does global obstetric billing include?
The global codes (59400, 59510, 59610, 59618) include routine antepartum visits, the delivery and routine postpartum care. They are billed once, after delivery.
What if a patient transfers care during pregnancy?
Each practice bills only the care it provided, using antepartum-only codes (59425, 59426), delivery-only codes or postpartum-only code 59430.
Are obstetric ultrasounds billed separately from the global package?
Yes. Ultrasounds are not part of the global obstetric package and are billed with their own codes when medically necessary.
Contact Us for More Details
To simplify your billing process and minimize the risk of error, and maximize reimbursements with your OBGYN, contact us today. We are prepared to respond to your inquiries, take you through our services, and offer customized services that will suit your work. We make sure that your revenue cycle is running smoothly by ensuring that we pay proper attention to accurate coding, clean claims submission and follow-ups.
Your staff will have more time to attend to more patients rather than writing papers, and your practice will be financially stable and compliant with our support. Call us today to find out how our professional billing system can make your OBGYN practice look and work better to help you bring in more profits.
Prefer to talk? Call +1 (469) 935-4617 or visit our contact page.