Specialty billing / OB/GYN
Obstetric billing works differently from every other specialty because most of the care is bundled into one global package billed after delivery. Visits accumulate for months with no cash flow, patients change plans mid-pregnancy, and the moment care is split between practices the global package has to be unwound into individual components.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
Routine antepartum visits, delivery and postpartum care are bundled. Problem visits for conditions unrelated to the pregnancy remain separately billable, and practices routinely fold them into the global package and never get paid for them.
When a patient transfers in or out mid-pregnancy, the global code no longer applies. Antepartum visits must be counted and billed with the correct partial care code, and delivery-only or postpartum-only codes used, or the claim will be rejected.
Nine months is long enough for a plan change, a Medicaid transition or a lost job. Because the global claim goes out at the end, eligibility problems that began months earlier surface only when the largest claim of the pregnancy is denied.
Obstetric ultrasounds are payable by indication, and each study needs a documented reason plus a permanent image and interpretation. Repeat scans without a new indication are denied as exceeding frequency limits.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
Routine antepartum visits, the delivery itself, and routine postpartum care. Not included: the initial confirmation of pregnancy visit, laboratory work, ultrasounds, and visits for problems unrelated to the pregnancy. Complications of pregnancy requiring additional evaluation are often separately billable when documented distinctly.
The global code no longer applies to either practice. Count the antepartum visits provided and bill the corresponding partial antepartum care code, then use delivery-only or delivery-with-postpartum codes as appropriate. Accurate visit counts are essential, because the code tier depends directly on how many visits were rendered.
Because the global claim is submitted only after delivery, while the coverage change may have happened in the second trimester. Running eligibility at every antepartum visit rather than only at intake catches plan changes while they can still be addressed, instead of at the point of the largest claim.
There is no universal number. Coverage follows indication, so each study needs a documented clinical reason, a permanent image, and an interpretation in the record. Routine scans performed on a schedule without a fresh indication are the ones that get denied. Documenting the specific question each scan answers is what supports the claim.
Routine postpartum care is included in the global package. Visits addressing a problem, such as postpartum depression evaluation, wound complications or contraceptive procedures, can be separately reportable when documented as distinct from routine follow-up. The note should show the specific issue evaluated rather than a routine check.
Other specialties
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
