Monday, November 28, 2011

OB/GYN Billing

As you know, obstetrics and gynecology are technically two separate medical specialties dealing with the female reproductive organs, differentiated by whether the woman is in a pregnant or non-pregnant state.  However, the two specialties are usually combined to form a single surgical-medical specialty which enables the physician to care for his or her patients prior to, during, and after pregnancies.  This creates a broad range of conditions that the practicing OB/GYN will treat and many different procedures that the physician will perform.
As an OB/GYN medical billing specialist, knowledge of the specialty is vital to ensuring that the billing is being handled correctly.  The medical biller must play close attention to detail.  They must understand what is included in a global obstetrical package, and what can be billed separately…for all insurance carriers.  They need to be knowledgeable on how to receive full reimbursement for all medications, injectibles, and devices the physician may use.
The medical biller must also have a complete understanding of Well Woman Exam coding.  The biller must know which insurance plans will pay when a G0101 (Cervical or Vaginal cancer screening), Q0091 (Screening papanicolaou smear), S0610 (New patient-annual gynecological exam), or S0612 (Established patient – annual gynecological exam) is submitted.  Some pay for a specific code, and some with a combination of the codes.  Other payers will pay when submitted with a Preventive Visit (9938*-9939* codes), and others when included with an Office Visit (9920*-9921* codes).  The biller must also know what diagnosis codes are required to be submitted with the above Procedure codes.
The OB/GYN specialty requires knowledgeable billers that have both education and experience handling all aspects of the specialty.  If the medical biller doesn’t understand exactly what the insurance carriers require so that the physician can receive full reimbursement, then the denied claims can accumulate rapidly.  No physician can afford an interruption in cash flow, especially if it is due to inexperience.  Every OB/GYN desires full reimbursement for his or her services, and it is vital to have a qualified biller that is up for the task.


  1. It is important to know the difference between the two since it is commonly confused. By doing medical billing at home you are sure to have focus on your job.

  2. Having no sufficient knowledge about medical billing, I found it a little complicated. All I see is the close relationship in between medical fields, insurance companies, and health care providers. advanced medical billing

  3. I get lost when trying to understand obgyn billing so i wanted to thank you for explaining this really simply and clearly. Thank You!

  4. I truly appreciate you for sharing this useful information. For proper medical billing services, knowledge of targeted specialty is required. The medical Billers must be knowledgeable on how they get full reimbursement of the rendered services.

  5. This is really good to know. My wife has been trying to find an OB/GYN in Pueblo, CO to visit and it's been tough. We have weird insurance so the billing is a big deal. This article has some great info that really helped us out. Thanks!

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  7. Hello,

    I loved the way you have discussed here. Ob/Gyn application provides an all-inclusive work flow for gynecological visits, post-partum care. Medical specialties Obstetrics and Gynecology deal with specific needs of a women's health. Medical Billing Services are companies that take the pain of collecting money out of the doctor's office.

  8. Thanks for the information! My wife is going in to the gynecologist, so it seems pretty useful to know how a medical biller will code and bill for this type of medical practice. It makes sense that medical billing professionals need to know all of the different aspects of OB/GYN practice. Thanks for the post!
    Bill Li |

  9. I didn't know how obstetrics and gynecology differed until now. That is an interesting tidbit of information. I have an appointment at the OBGYN soon. After reading this, I will have to pay attention to the billing.
    Emily Smith |

  10. you need to know how to code accurately for visits outside of the global ob package, lysis of adhesions during another procedure, complex annual visits, and more. Washington Medical Billing

  11. Many Ob-Gyn specialists face medical billing and coding pitfall due to Current Procedural Terminology (CPT) and Medicare code changes. Many complications like pregnancy coverage, patient collection process, multiple procedure rules etc. also affect Ob-gyn coding.

  12. This comment has been removed by the author.

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