OB/GYN billing turns on
one bundled code.
Obstetrics is the only specialty where a single code covers nine months of care, and most of what goes wrong is a version of the same question: does the global package still apply to this patient. Gynecology has its own problems, and one of them is buy-and-bill in a practice that has never thought of itself that way.
One code covers nine months, right up until it does not
Routine antepartum care, the delivery and postpartum are bundled into a single global code. That holds until the patient transfers in at twenty weeks, or changes insurance in the third trimester, or moves away before the postpartum visit. Then the global does not apply and the care has to be itemised to what was actually provided. Practices that bill global anyway are either denied outright or paid for rather less than they delivered.
- Global eligibility determined per patient rather than assumed at delivery
- Antepartum visit count tracked, because it decides whether global applies at all
- Transfers in and out itemised to the care actually given
- Insurance changes mid-pregnancy split at the date of change
A planned delivery that changes is a different claim
The code follows how the delivery went, not how it was booked. A planned vaginal delivery that becomes a caesarean, a vaginal birth after caesarean, twins, an attempted delivery followed by a section: each has its own code and its own rules about what else is separately reportable. Coding from the booking rather than the operative note is common, and it is expensive in both directions.
- Delivery coded from the operative note rather than the scheduled plan
- Multiple gestation and high-risk services identified as sitting outside the global
- Complications examined for what is separately reportable rather than absorbed
LARC is buy-and-bill in a practice that does not think of itself that way
An IUD or implant is bought by the practice and billed alongside the insertion, which puts a gynaecology office in the same territory as an infusion suite: device cost carried up front, prior authorization, brand-specific coverage, and a claim that has to carry both the device and the procedure. Treat it as a procedure with an incidental supply attached and you are financing the device on the payer behalf.
- Device and insertion billed as the two separate lines they are
- Brand coverage confirmed per payer before the device is ordered
- Removal and reinsertion distinguished, because they price differently
- Inventory exposure surfaced before the practice is carrying it
The well-woman visit that turned into a problem visit
A preventive visit and a problem-oriented visit on the same day are both payable when the problem work is genuinely separate and the note shows it. Without that, one of them denies, and which one depends on the payer. This is the most common same-day denial in gynaecology and it is a documentation problem wearing a coding costume.
- Preventive and problem components documented separately in the note
- Modifier 25 applied where the problem work is genuinely significant and separate
- Payer-specific preventive policies applied rather than one house rule
Ultrasound is where the professional and technical split bites
Obstetric ultrasound is billed as a professional component, a technical component or globally, depending on who owns the machine and who read the study. Getting that split wrong underpays quietly instead of denying loudly, which is why it can run for a year. Payers also cap how many scans they cover without a documented indication, and a routine extra scan without one is unbillable after the fact.
- Professional and technical components assigned from who actually did what
- Scan counts tracked against payer limits before the appointment
- Medical necessity documented for scans beyond the routine allowance
This is what we watch for. How the engagement runs is a separate question.
Before any of it applies to your practice we read your aged A/R and the last quarter of remittance advice, and you get the findings in writing including what we think is not worth chasing. You keep your practice management system, your payer contracts and your NPI throughout.