OB-GYN practices manage one of the widest billing scope ranges in outpatient medicine: annual wellness visits, preventive screenings, in-office procedures, surgical care, and obstetric global packages. Each category has different billing rules, payer requirements, and documentation standards. Vajra Healthcare manages gynecology revenue cycle operations across the full clinical scope of the specialty.
The obstetric global package bundles antepartum care, delivery, and postpartum care into a single payment. The number of antepartum visits included in the global varies by payer. When care is split between providers or the patient changes insurers during pregnancy, global package billing must be unbundled correctly to avoid revenue loss.
Gynecologic surgical procedures including hysterectomies, laparoscopies, myomectomies, and cystoscopies involve complex CPT coding with global surgery periods. Services rendered during the global surgery period cannot be billed separately unless they meet specific criteria, and failure to manage the global period correctly creates compliance exposure.
Annual gynecologic exams, Pap smears, HPV testing, and mammogram referrals fall under preventive benefit rules that vary significantly by payer and plan type. Billing a preventive visit with the wrong diagnosis code can shift it from a covered preventive service to a cost-sharing office visit, creating unexpected patient bills and denial risk.
IUD insertions, colposcopies, endometrial biopsies, and LEEP procedures performed in the office setting require specific procedure codes with correct diagnosis linkage and modifier usage when performed on the same day as an evaluation and management visit.
The Affordable Care Act requires most plans to cover contraceptive services without cost sharing when billed correctly. Incorrect billing of contraceptive counseling or IUD insertion can result in patient cost sharing that should have been waived, generating patient complaints and potential compliance issues.
When a patient receives antepartum care from one provider and delivery from another, or when care transfers between practices mid-pregnancy, the global package must be split and each provider billed only for the specific services rendered. This requires careful coordination and correct use of obstetric billing codes for each phase of care.
For obstetric patients, confirming maternity coverage, deductible requirements, and any prior authorization requirements for the global package or delivery facility before care begins.
Tracking antepartum visits to correctly apply the obstetric global package billing at delivery, and managing unbundling when care transfers or insurance changes during pregnancy.
Accurate CPT coding for surgical procedures, in-office procedures, and preventive services with correct diagnosis linkage to ensure services are billed under the correct benefit category.
Submitting authorization for surgical procedures including hysterectomies, laparoscopies, and other major gynecologic surgeries with clinical documentation supporting medical necessity.
Electronic submission with correct global package codes, surgical billing, and preventive service codes. Insurance payments posted and reconciled against contracted rates.
Gynecology denials commonly involve global package disputes, medical necessity for surgical procedures, and preventive versus diagnostic benefit category disagreements. Each type requires specialty-specific appeal documentation.
Outstanding balances followed up systematically. Monthly reporting on collections, surgical procedure reimbursement performance, and denial trends by service category.
Let us manage your obstetric billing and surgical coding so your practice captures what it has earned from every patient served.
Schedule a consultation to review your gynecology billing operations and understand how Vajra Healthcare can reduce denials and improve collections.
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