Managing an OBGYN billing service is not a cakewalk for everyone. Changing regulations, complex payer policies, and coding guidelines always make your billing process a challenging affair. Staying updated with all the recent changes is always crucial for you, especially in today’s competitive healthcare landscape. Always remember that a single coding error or piece of missing information could lead your practice to see claim denials, delayed payments, and loss of revenue. You must focus on making your billing system well-structured to ensure seamless reimbursements and financial stability.
Fortunately, you can strengthen your billing mechanism by understanding the global period and commonly used codes.
Have a clear understanding of the global period in your billing system:
- The global period is the set time when additional care is already covered in the main payment for a service. In OBGYN care, the global period for pregnancy includes all visits before, during, and after delivery. For surgeries, the length of the global period depends on the type of procedure performed. It starts from the first visit after confirming the pregnancy and continues through postpartum care—56 days for a vaginal delivery and 90 days for a C-section. Understanding these timelines helps ensure accurate billing and prevents claim denials.
- A patient’s history review and physical exam before major surgery are included in the global package and should not be billed separately. These preoperative services are considered part of the overall surgical care. Billing them separately can lead to claim denials or compliance issues. Understanding what’s covered under the global period ensures accurate claims and prevents unnecessary payment delays.
- You can bill separately if you’re performing a surgical clearance for a patient with conditions like high blood pressure or heart problems. However, in most cases, another doctor handles these evaluations. If you do provide the clearance, proper documentation is essential to justify separate billing and avoid claim issues.
- Most hospital procedures have a global period of either 10 or 90 days, meaning related check-ups or evaluations can’t be billed separately during this time. Follow-up care after a procedure is already covered in the initial payment. Using the right modifiers helps ensure proper reimbursement. Misusing modifiers can lead to claim denials or compliance issues.
Now, you need to know about the frequently used CPT codes in your billing practice:
Frequently used CPT codes in your OBGYN billing service:
- Use code 59400 for routine pregnancy care in your OBGYN center. It includes all check-ups, vaginal delivery (with or without episiotomy or forceps), and postpartum care.
- Use code 59510 for routine care, including check-ups, C-section delivery, and postpartum care.
- Use code 59610 for care that includes check-ups, vaginal delivery (with or without episiotomy or forceps), and postpartum care after a previous C-section.
- Use code 59618 for care that includes check-ups, a C-section, and postpartum care after attempting a vaginal delivery following a past C-section.
- Bill the global OB code when the same group handles all pregnancy care. Don’t bill separately for each check-up—it’s all included in the package!
You need a solid strategy to make your OBGYN billing services smooth and efficient. Unfortunately, you cannot expect an error-free billing system without a professional and experienced billing team. However, you still can stay on top of the global period, and newly updated codes and ensure a perfect billing system by hiring a professional OBGYN billing service. A professional company always knows what it takes to streamline a perfect billing mechanism so that you can enjoy minimized claim denials and maximized revenue outcomes. So, don’t waste a minute and gain momentum with a reliable billing partner.
