Specialty Billing
OB/GYN Medical Billing Services
Billing for OB/GYN practices — global maternity packages with their timing and transfer complications, GYN procedures, and the Medicaid-heavy Texas maternity landscape.
Obstetric billing is built around the global maternity package — antepartum care, delivery, and postpartum bundled into one claim whose rules break whenever reality intervenes: patients transferring in or out mid-pregnancy, coverage changing before delivery, complications requiring separately billable care, or multiple providers sharing the episode.
Our OB/GYN billing manages the package lifecycle patient by patient — visit counts tracked, transfers split correctly, non-global services unbundled where rules allow — alongside disciplined GYN surgical and office procedure billing.
Why OB/GYN Billing Is Complex
Global maternity claims fail at the edges: how many antepartum visits occurred before a transfer decides whether the package or itemized codes apply; coverage changes mid-pregnancy (common with Texas Medicaid enrollment timing) split the episode across payers; and complication care must be documented as outside routine antepartum care to bill separately. Texas adds a large Medicaid maternity share with MCO variation and postpartum coverage windows that have changed in recent years.
Common Service Categories We Bill
- Global obstetric care and deliveries
- High-risk pregnancy management
- GYN surgery: hysterectomy, laparoscopy, hysteroscopy
- Office procedures: colposcopy, LEEP, IUD services
- Well-woman and preventive visits
Common Denial Causes in OB/GYN
- Global package disputes on transfers and split episodes
- Mid-pregnancy coverage changes fragmenting the claim
- IUD device-and-insertion billing errors
- Medicaid MCO maternity rule variation
Documentation Risks to Watch
- Antepartum visit counts untracked for package-versus-itemized decisions
- Complication visits not documented as distinct from routine care
- Delivery notes missing elements for delivery-type coding
Coding Considerations
- Package versus itemized antepartum coding turns on documented visit counts — the tracking must exist from the first OB visit
- Delivery coding differentiates by type and by what the same physician’s group provided across the episode
Educational note: Coding and payer information on this page is general educational content, not definitive coding, legal, or reimbursement advice. CPT/ICD-10 rules and payer policies change frequently — verify specifics against current official sources and qualified professionals.
Typical Payer Challenges
- Texas Medicaid maternity volume across multiple MCOs
- Postpartum coverage window rules affecting late-episode claims
OB/GYN Billing FAQs
A patient transferred to us at 28 weeks — how does the maternity billing work?
The episode splits: the prior practice bills its antepartum visits itemized (or partial package where payer rules define one), and your practice bills for the care it provides — potentially delivery-plus-postpartum with itemized antepartum, depending on visit counts and the payer’s package rules. The key is documented visit counts from day one; we track them per patient.
Why did the payer deny visits during a pregnancy as “included in global”?
Payers default everything in the window into the package unless documentation and coding mark it as outside routine antepartum care — complications, unrelated problems, or high-risk services beyond the package definition. We code those encounters with the distinctions payers require and appeal package-swallowed claims with the notes.
Related Specialties and Texas Locations
Information on this website is provided for general educational purposes only and does not constitute legal, medical, coding, reimbursement, payer, or compliance advice. Coding and payer requirements change frequently; verify current rules with official sources and qualified professionals before acting.
Talk to us about ob/gyn billing
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