OB/GYN RCM

OB/GYN Billing: Global Obstetric Packages, Gyn Surgery & In-Office Procedures

From the 40-week OB global package to same-day preventive-plus-problem visits, our OB/GYN-certified team turns complex documentation into complete, clean claims.

98.6% Clean Claim Rate
21% Average Revenue Increase
12 Days Average Days in AR
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The Challenge

Why OB/GYN Billing Needs Specialists

Few specialties blend longitudinal care, surgical billing, and preventive services as tightly as OB/GYN. A single patient can move through 13 antepartum visits, a delivery, postpartum follow-up, and annual gyn visits, each with different bundling rules.

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Global OB Package

59400, 59510, 59610, and 59618 bundle antepartum, delivery, and postpartum. When patients switch plans or providers mid-pregnancy, we unbundle into 59425/59426, 59409/59514, and 59430.

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Preventive + Problem Same Day

When an annual well-woman visit uncovers a problem, billing both 99381-99397 and a problem-oriented E/M with modifier 25 requires careful documentation. We audit to defend the modifier.

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Colposcopy & LEEP Coding

57452-57461 and 57522 require documentation of cervical findings, biopsy sites, and ECC. We apply modifier 59 when distinct procedural services are separately billable.

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Hysterectomy & Myomectomy

Laparoscopic (58570-58573), abdominal (58150-58294), and vaginal (58260-58294) hysterectomy each have distinct codes. Modifier 22 applies for severe adhesions, large uteri, or complex anatomy.

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Contraceptive & IUD Billing

IUD insertion/removal (58300/58301) plus device J-codes (J7297, J7298, J7300) require ACA preventive verification, NDC tracking, and unit reconciliation.

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Gender Edit Denials

Gender-specific CPT and ICD edits cause automatic denials when payer member records are incorrect or transgender patients are mis-flagged. We troubleshoot eligibility before claims submit.

Our Approach

OB/GYN-Certified Billing From Prenatal to Post-Op

Our OB/GYN team holds CPC credentials with specialty OB/GYN focus, stays current on ACOG coding updates, and understands the longitudinal arc of pregnancy care. Every global OB episode is tracked visit by visit.

  • Global OB package tracking with automatic unbundling when patients switch plans or providers
  • Antepartum visit logging so partial-care billing (59425/59426) is accurate to the visit count
  • Modifier 22 documentation support for complex surgical cases
  • Preventive + problem-oriented audits with modifier 25 justification on every claim
  • IUD/device J-code reconciliation including ACA preventive coverage verification
  • High-risk OB/MFM coordination outside the global package for consults, NSTs, and BPPs
OB/GYN physician with pregnant patient
21% Average Revenue Increase
48hrs Claim Submission Turnaround
97% First-Pass Resolution Rate
12 Days Average Days in AR
Compliance & Security

HIPAA-Compliant OB/GYN Billing Operations

OB/GYN data includes highly sensitive reproductive health, pregnancy, and surgical records. Our operations align with HIPAA, ISO 27001, and HITRUST CSF.

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HIPAA & Reproductive Privacy

All PHI lives in encrypted, access-controlled systems with full audit trails. Our team is trained on reproductive health privacy and state-specific minor-consent rules.

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ISO 27001 & HITRUST

Information security management aligned with ISO/IEC 27001 and HITRUST CSF. Continuous monitoring, vulnerability management, and documented incident response protect your practice's data.

FAQ

OB/GYN Billing Questions Answered

Related Services

Billing & AR Medical Coding Denial Management Eligibility & VOB Prior Authorization
The global OB package (59400 for vaginal delivery, 59510 for cesarean, 59610 for VBAC, 59618 for failed VBAC) bundles antepartum care (typically 13+ visits), delivery, and postpartum care into a single code. If a patient changes carriers or providers mid-pregnancy, we unbundle into antepartum only (59425 for 4-6 visits, 59426 for 7+), delivery only (59409, 59514, 59612), and postpartum only (59430) to capture every service rendered.
We track every antepartum visit so that if the patient doesn't complete the full global package with your practice, we switch to 59425/59426 for partial antepartum and 59430 for postpartum only. We also handle high-risk OB visits (99202-99215) separately when medically necessary and document co-morbidity diagnoses.
Yes. We code colposcopy (57452-57461) with cervical biopsy and ECC, LEEP (57522), endometrial sampling (58100/58110), hysteroscopy (58558-58565), laparoscopic and abdominal hysterectomy (58150-58294, 58541-58554, 58570-58573), and myomectomy (58140-58146). Each procedure carries its own global period, NCCI edits, and bundling rules we apply automatically.
Modifier 22 (increased procedural services) is used when documentation supports additional work, extended surgery time, severe adhesions, or unusual complexity. Modifier 25 captures a significant, separately identifiable E/M on the same day as a procedure (common in gyn office visits). Modifier 59 unbundles distinct procedural services when NCCI edits would otherwise bundle them. We audit documentation to support every modifier.
Preventive visits (99381-99397) cover annual wellness, Pap screening, and contraceptive counseling. When a problem is addressed during a preventive visit (abnormal bleeding, pelvic pain), we bill both a preventive code and a problem-oriented E/M (99202-99215) with modifier 25. Commercial payer rules vary, we maintain a payer matrix to prevent denials.
Yes. We bill IUD insertion (58300), removal (58301), and the J-codes or HCPCS for the device itself (J7297, J7298, J7300, J7301, J7307). We verify preventive coverage under ACA, handle manufacturer buy-and-bill vs. patient-supplied devices, and track device NDC/units for accurate reimbursement.
Absolutely. We bill MFM consultations, antepartum NSTs (59025), biophysical profiles (76818/76819), amniocentesis (59000), cerclage (59320/59325), and high-risk OB E/M visits outside the global package. Diagnosis pairing (preeclampsia, gestational diabetes, placenta previa) drives medical necessity for additional services.
We integrate with athenahealth, Epic OB, AdvancedMD, eClinicalWorks, Cerner, Kareo, OB/GYN-specific systems like OB-One, and hospital L&D documentation platforms. Our team configures OB flow sheets, global-package tracking, and preventive-vs-problem decision trees inside your existing system.
Top OB/GYN denials: bundled E/M during global period, missing modifier 25 on same-day preventive + problem visits, unsupported modifier 22, and gender-edit denials. We analyze denial trends monthly, appeal with operative note excerpts, and coach providers on documentation that supports modifier use.
Related Specialties

Adjacent Women's Health & Surgical Specialties

Plastic Surgery ›

Cosmetic vs. reconstructive billing and global period management.

ASC ›

Ambulatory surgery center billing for in-office gyn procedures.

Independent Practices ›

Full-cycle RCM for solo and small-group OB/GYN practices.

Gynecologic Oncology ›

Complex cancer billing including chemotherapy administration and drug J-codes.