Obstetrics and Gynecology (OB/GYN)

Billing for OB/GYN has many issues that are unique to this speciality. At MEDX we are fully trained and experienced to deal with situations such as:

  1. Will the well woman exam be covered by insurance? If so is there a different copay, deductible or coinsurance? Is their a time restriction or plan exclusion for the service?
  2. What if the well woman exam confirms pregnancy? How do you bill for the visit if all pregnancy related visits are covered under the global fee?
  3. If the woman is in for a “sick” visit but has not had a well woman check for an extended period of time and lab tests are performed how are these billed?
  4. After pregnancy confirmation how are the prenatal visits tracked? Should they be tracked within the billing system?
  5. During prenatal care if the patient changes insurance plans which carrier becomes responsible for the global fee after delivery?
  6. During prenatal care if the patient transfers care to another physician or has a loss of pregnancy how are visits billed up to that point?
  7. If lab services are performed during prenatal visit can they be billed separately?
  8. Is the practice a solo, group, or several individual physicians functioning like a group for cross coverage?
  9. Knowing the appropriate method to bill for the on-call physician who performs an unscheduled delivery.
  10. Using the correct CPT codes for a delivery that has multiple gestations.
  11. When unexpected or unrelated complications arise during the visit or surgery (post-op or post-partum period) checking for CCI edits, possible bundling, or global inclusion become necessary in sending out a “clean” insurance claim.
  12. Is family planning counseling being billed using the correct modifier & diagnosis when a procedure is also performed.
  13. If the physician performs a circumcision after the delivery of a male infant how is it submitted to the insurance carrier (ie. under the mothers insurance as a dependent)?