OB/GYN Medical Billing Experts
Maximize your obstetrics and gynecology practice revenue with specialized billing for deliveries, surgical procedures, and office visits. Expert global OB package management, GYN surgery coding, and comprehensive revenue optimization.
OB/GYN Services
- Obstetrics Global Package Billing
- GYN Surgical Procedure Coding
- Delivery & C-Section Optimization
- Office Procedure Billing
- Preventive Care Coding
- Pathology Coordination
Industry-Leading OB/GYN Billing Performance
Our specialized OB/GYN billing consistently outperforms benchmarks
OB/GYN Billing Challenges We Solve
Complex obstetrics and gynecology coding requires specialized expertise
Global OB Package vs Individual Services
OB global packages (CPT 59400, 59510) bundle prenatal visits, delivery, and postpartum care. Understanding when to bill globally vs itemizing services (for transfers, complications, or late entries) is critical. Incorrect global billing causes significant denials.
Global package errors cost average OB practice $85,000 annually
Delivery and Surgical Coding Complexity
Delivery procedures require precise coding differentiating vaginal from cesarean, VBAC attempts, and multiple births. Add-on codes for twins (59409-modifier), cesarean complications, and delivery-only services must be properly documented.
Delivery coding errors reduce reimbursement by 15-30% per case
Prenatal Visit Frequency and Documentation
Global OB packages include specific number of prenatal visits (typically 13). Additional visits require medical necessity documentation. High-risk pregnancy monitoring, ultrasounds, and NSTs need separate coding justification.
Improper prenatal visit billing triggers $40K+ in audit takebacks
GYN Surgical Procedure Bundling
Hysterectomies, laparoscopic procedures, and D&Cs have complex bundling rules. Bilateral procedures, multiple surgical approaches (vaginal, abdominal, laparoscopic), and concurrent procedures require proper modifier usage.
Surgical bundling errors cause 22% of GYN surgery denials
Office Procedure Coding
In-office procedures like colposcopies, endometrial biopsies, IUD insertions, and LEEP procedures require detailed documentation. Pathology coordination, concurrent E/M billing with modifier 25, and supply billing often missed.
Office procedure revenue loss averages $2,500 monthly per provider
Preventive vs Problem-Focused Visits
Annual exams, well-woman visits, and preventive screenings use different codes than problem-focused GYN visits. When problems are addressed during preventive visits, modifier 25 on E/M code is required but frequently denied without proper documentation.
Modifier 25 denials cost practices $15K-25K annually
Comprehensive OB/GYN Service Coverage
Expert billing across all obstetrics and gynecology services
Obstetrics - Delivery Services
Comprehensive obstetrical care including global packages and delivery-only services.
Vaginal Delivery (Global)
$4,200CPT 59400
Antepartum, delivery, postpartum care
C-Section (Global)
$5,800CPT 59510
Cesarean delivery with complete care
VBAC Attempt
$4,500CPT 59610-59614
Vaginal birth after cesarean
Twin Vaginal Delivery
$5,600CPT 59400 + 59409-51
Multiple gestation delivery
Billing Note: Document all prenatal visits, complications, and transfers of care to support global or itemized billing.
Prenatal Care & Monitoring
Antepartum care, ultrasounds, and high-risk pregnancy monitoring.
Antepartum Care Only (4-6 visits)
$850CPT 59425
Prenatal care without delivery
Antepartum Care (7+ visits)
$1,200CPT 59426
Extended prenatal management
OB Ultrasound Complete
$280CPT 76805
Comprehensive fetal assessment
Non-Stress Test (NST)
$85CPT 59025
Fetal heart rate monitoring
Billing Note: Track visit counts carefully - global packages include specific visit numbers; excess visits need documentation.
Gynecologic Surgery
Major and minor GYN surgical procedures including hysterectomies and laparoscopic surgery.
Total Abdominal Hysterectomy
$3,800CPT 58150
Removal of uterus, abdominal approach
Laparoscopic Hysterectomy
$4,200CPT 58262
Minimally invasive hysterectomy
Myomectomy (Abdominal)
$3,200CPT 58140
Fibroid removal
Laparoscopic Oophorectomy
$2,400CPT 58661
Ovary removal, laparoscopic
Billing Note: Document surgical approach, complexity, adhesions, and concurrent procedures for proper code selection.
Office-Based GYN Procedures
In-office diagnostic and therapeutic procedures.
Colposcopy with Biopsy
$420CPT 57454
Cervical examination with tissue sampling
Endometrial Biopsy
$280CPT 58100
Uterine lining sampling
LEEP Procedure
$680CPT 57522
Loop electrosurgical excision
IUD Insertion
$240CPT 58300
Intrauterine device placement
Billing Note: Bill E/M separately with modifier 25 when significant evaluation beyond procedure is documented.
Preventive & Well-Woman Care
Annual exams, preventive screenings, and contraceptive counseling.
Annual GYN Exam (Ages 18-39)
$220CPT 99385
Preventive medicine visit
Annual GYN Exam (Ages 40-64)
$240CPT 99386
Well-woman examination
Pap Smear (Conventional)
$45CPT 88164
Cervical cytology screening
HPV Testing
$95CPT 87624
High-risk HPV detection
Billing Note: Separate preventive visit codes from problem-focused E/M codes; use appropriate ICD-10 screening codes.
OB/GYN Practice Success Stories
Real results from OB/GYN practices we've transformed
Multi-Provider OB/GYN Practice Optimization
6 physicians, 2 midwives - full-spectrum practiceChallenge
Practice losing $150K annually on global OB package errors, 18% GYN surgery denial rate, and inconsistent modifier 25 usage causing preventive visit denials.
Solution
Implemented OB global tracking system, created surgical documentation templates with bundling alerts, trained staff on modifier 25 requirements, and established pathology coordination protocols.
Results
- ✓Global OB billing accuracy increased from 81% to 98%
- ✓GYN surgery denial rate reduced from 18% to 2.4%
- ✓Modifier 25 acceptance rate improved to 94%
- ✓Annual revenue increase of $285,000
High-Volume Obstetrics Group Revenue Recovery
OB-focused practice - 450 deliveries annuallyChallenge
Delivery coding inconsistencies costing $90K annually, transfer of care documentation gaps causing global package denials, twin delivery billing errors.
Solution
Standardized delivery documentation checklists, implemented transfer tracking system, created multiple gestation billing protocols, trained physicians on proper global package usage.
Results
- ✓Delivery coding accuracy: 99.2%
- ✓Transfer of care denials eliminated
- ✓Twin delivery reimbursement optimized
- ✓Captured $175,000 in previously lost revenue
GYN Surgery Center Excellence
Dedicated GYN surgery practice with ASCChallenge
Laparoscopic procedure bundling errors, hysterectomy approach coding inconsistencies, concurrent procedure denials costing $60K annually.
Solution
Deployed GYN surgery coding specialists, implemented surgical approach decision trees, created concurrent procedure documentation requirements, optimized ASC facility billing.
Results
- ✓Laparoscopic coding accuracy: 98%
- ✓Hysterectomy average reimbursement increased 22%
- ✓Concurrent procedure denials eliminated
- ✓Practice revenue increase of $240,000
OB/GYN Billing Questions Answered
Expert answers to your OB/GYN billing questions
How do you handle global OB package billing vs itemized services?
We implement comprehensive tracking systems monitoring every patient from first prenatal visit through postpartum care. For global packages (59400 vaginal, 59510 cesarean), we verify the physician provided antepartum care (typically 13 visits), delivery, and postpartum care. When patients transfer in late pregnancy, we use antepartum-only codes (59425, 59426) or delivery-only codes (59409, 59514). For patients who transfer out before delivery, we bill appropriate partial global codes. Our system automatically flags cases where global billing may be inappropriate, preventing the costly denials that occur when practices incorrectly bill global packages.
What is your approach to delivery coding for different scenarios?
Delivery coding requires precise documentation of delivery method and any complications. Vaginal delivery (59400 global or 59409 delivery-only) vs cesarean (59510 global or 59514 delivery-only) must be clearly documented. VBAC attempts have specific codes (59610-59614) depending on outcome. For multiple gestations, we bill primary delivery code plus add-on code (59409 with modifier 51 for second twin). Delivery complications requiring additional procedures (repair of 3rd/4th degree laceration, manual placenta removal) are billed separately. We ensure operative notes support all codes submitted.
How do you maximize reimbursement for GYN surgical procedures?
GYN surgery optimization starts with accurate approach documentation - vaginal, abdominal, or laparoscopic hysterectomy each has different codes and reimbursement. We ensure operative notes document complexity factors: adhesions, endometriosis, enlarged uterus size, concurrent procedures. For unusually complex cases, modifier 22 with detailed documentation can increase reimbursement 20-30%. Bilateral procedures (like oophorectomy) require modifier 50. We coordinate multiple concurrent procedures properly - major procedure coded first, additional procedures with modifier 51. This attention to detail increased our clients' average hysterectomy reimbursement by 22%.
Can you help with office procedure billing and pathology coordination?
Yes, office GYN procedures like colposcopy, LEEP, and endometrial biopsy require careful coding and pathology coordination. We ensure procedure codes match pathology specimen collection. For colposcopy with biopsy (57454), each specimen jar is tracked for separate pathology billing. LEEP procedures (57522) include specimen pathology. When E/M service occurs same day as procedure, we ensure proper modifier 25 usage with documentation showing significant, separately identifiable evaluation. Supply codes (HCPCS J codes for medications, A codes for supplies) are captured. This comprehensive approach prevents the $2,500 monthly revenue loss typical from incomplete office procedure billing.
How do you handle preventive visit billing with problem-focused services?
Annual well-woman exams use preventive medicine codes (99385-99387) which have different reimbursement than problem-focused E/M codes. When significant problem is addressed during preventive visit, we can bill both: preventive code for the annual exam plus E/M code (99213-99215) with modifier 25 for the problem. However, this requires clear documentation showing the problem-focused service was significant and separately identifiable from the preventive exam. Our documentation templates prompt for: separate chief complaints, distinct problem documentation, and appropriate ICD-10 codes (Z01.411 for screening plus specific problem codes). This prevents the common modifier 25 denials while maximizing legitimate revenue.
What about ultrasound and monitoring services during pregnancy?
Prenatal ultrasounds and monitoring are separately billable from global OB packages when medically necessary. Complete OB ultrasound (76805) requires documentation of all required elements per trimester. Limited ultrasounds (76815) for specific indications like fetal position need medical necessity. Non-stress tests (59025) for high-risk monitoring are separately billable. Biophysical profiles (76818-76819) combine ultrasound and NST. We ensure documentation supports medical necessity for each study - routine screening vs diagnostic indication. Proper coding coordination with radiologist interpretation when applicable. This captures important ancillary revenue averaging $8,000-12,000 annually per OB provider.
How do you stay current with OB/GYN coding changes?
Our OB/GYN coding team includes AAPC-certified coders with specialty credentials. We monitor annual CPT changes affecting OB/GYN codes, payer policy updates for global packages, and changing guidelines for preventive services. Recent important changes include updated guidelines for VBAC coding, revised twin delivery billing, new codes for specific laparoscopic procedures, and changing payer policies on modifier 25 with preventive visits. We attend ACOG coding updates, participate in national OB/GYN coding forums, and maintain relationships with specialty coding experts. When new procedures are introduced (like minimally invasive hysterectomy variations), we research appropriate coding immediately.
What metrics should OB/GYN practices monitor for revenue optimization?
Key OB/GYN metrics include: global OB package accuracy rate (target: 95%+), average delivery reimbursement (vaginal: $4,200+, cesarean: $5,800+), GYN surgery clean claim rate (target: 95%+), modifier 25 approval rate (target: 90%+), office procedure capture rate, ultrasound utilization, denial rate (target: <3%), and days in AR (target: <30 days). We provide monthly scorecards tracking these metrics by provider, identifying outliers for education. Physician-specific benchmarking reveals coding patterns - some physicians consistently undercode deliveries, others miss billable monitoring services. This data-driven approach enables targeted improvement.
Optimize Your OB/GYN Practice Revenue
Join hundreds of obstetricians and gynecologists who have increased revenue by 24% with our specialized billing services. Get a free practice analysis today.
✓ Global OB specialists ✓ GYN surgery experts ✓ Office procedure optimization