OB/GYN Medical Billing Services
Obstetric care is billed as a global package covering months of care in a single code, which means a patient who transfers in or out mid-pregnancy breaks the model. Most OB billing problems are really global package problems.
Codes this specialty bills most
| Code | Description | Watch for |
|---|---|---|
| 59400 | Routine obstetric care including antepartum care, vaginal delivery and postpartum care | The global package. Only correct where one practice provided the full course of care. |
| 59510 | Routine obstetric care including antepartum care, cesarean delivery and postpartum care | The cesarean equivalent of the global package. |
| 59425 | Antepartum care only, 4 to 6 visits | For transferred care. 59426 covers 7 or more visits. |
| 57454 | Colposcopy of the cervix with biopsy and endocervical curettage | Requires a documented indication, usually an abnormal cytology result. |
The denials this specialty sees
Transferred care is the recurring failure. A patient starts prenatal care elsewhere and transfers at 24 weeks. Billing the global package for a delivery you did but antepartum care you did not is an overbill, and it will be recovered.
The correct approach is itemized antepartum coding based on the number of visits your practice actually provided, plus the delivery. Practices get this wrong in both directions, and the underbilling direction is more common and never noticed.
The second pattern is separately billable care during the global period. Pregnancy does not suspend other medical problems. A patient treated for something unrelated is a billable encounter, but the note has to establish that it was unrelated. Where it does not, the visit is bundled. See CO-97.
Third is medical necessity on gynecological procedures. Colposcopy and hysteroscopy denials generally trace back to a claim that did not carry the diagnosis establishing why the procedure was indicated. See CO-11.
Our billing team tracks visit counts per pregnancy so transferred care is billed on evidence rather than on an estimate.
Payer notes
Medicaid programs frequently require their own antepartum reporting during the pregnancy rather than a single global claim after delivery, and the requirements differ by state.
Some commercial payers require the delivery date and the number of antepartum visits on the claim. A global claim missing them will be pended rather than denied, which is easy to lose track of.
Common questions
How do we bill a patient who transferred to us at 20 weeks?
Not with the global package. Bill itemized antepartum care based on the number of visits you provided, plus the delivery and postpartum care separately. The visit count decides which antepartum code applies.
Can we bill for a non-pregnancy problem during the global period?
Yes, when the problem is genuinely unrelated to the pregnancy and the note shows it. Pregnancy-related complications are part of the package.
Why are our colposcopies denying?
Usually because the claim does not carry the diagnosis establishing the indication. An abnormal cytology result belongs on the claim, not only in the chart.
See what your claims are leaving behind
Send us a month of remittance data and we will tell you what it says: which codes are being denied, how much of it is recoverable, and how long your money is sitting in A/R. It takes about a week and there is nothing to sign.