OB/GYN Medical Billing Services

OB/GYN Billing: Where the Global Package Decides Everything

OB/GYN billing is unusual because a single code can represent nine months of care. The global maternity package rolls routine antepartum visits, the delivery, and postpartum care into one charge billed once — and that structure is the source of both the specialty's biggest revenue and its most common leakage. Handle the global correctly and the practice is paid fully and cleanly; handle it carelessly and you either under-bill an entire pregnancy or trip a compliance edit. On the gynecology side, the challenge shifts to the preventive-versus-problem line and a procedure list that spans the office and the OR.

The Global Maternity Package, Decoded

Codes like 59400 (vaginal delivery), 59510 (cesarean), and 59610 (VBAC) bundle the whole routine episode and are reported once, after delivery — not visit by visit. The trap is that the global assumes your practice provided the entire episode and a typical number of antepartum visits. When it did, billing global is correct and pays best. When it didn't — because the delivering physician also owns the whole pregnancy — the global is the right call. The nuance is real and worth getting right on every case.

When to Unbundle: Transfers, Coverage Changes, and Split Care

Real pregnancies don't always fit the global. Patients transfer care mid-pregnancy, change insurance between trimesters, or receive antepartum care from one practice and delivery from another. In those cases you unbundle — billing antepartum-only codes (59425 for 4–6 visits, 59426 for 7 or more), delivery-only, or postpartum-only — so each provider is paid for what they actually did. Defaulting to the global when care was split is a compliance exposure; defaulting to itemized when you owned the whole pregnancy quietly underpays. We make the call case by case, which is exactly where a template-driven billing service loses money.

Well-Woman vs Problem-Oriented Visits

A large share of gynecology revenue is preventive well-woman exams (99385–99387, 99395–99397) — but when a patient brings a real problem to the same visit, a separately identifiable problem E/M can be reported alongside the preventive code with modifier 25. Payers watch this pairing closely, so the documentation has to clearly support two distinct services, and the correct code has to reflect whether the visit was preventive, diagnostic, or both. Getting the preventive-versus-diagnostic determination wrong produces PR-49 and CO-167 denials — and confused patient balances. Our E/M code calculator supports defensible leveling on the problem side.

Ultrasounds, Procedures, and the Denial Patterns

OB ultrasounds (76801, 76805, 76811, 76815) carry frequency and medical-necessity edits and a professional/technical component split that has to be billed correctly by setting. Gynecologic procedures — colposcopy, LEEP, endometrial biopsy, IUD insertion and removal — each have their own coding and bundling rules, and same-day procedure-plus-visit claims raise the familiar CO-97 bundling question. We bill to the documented indication, track payer frequency limits, and monitor the practice's denial rate so the patterns surface before they cost a quarter of revenue.