SpecialtiesSurgical
How we see ob/gyn billing.
Reviewed by the VisMed surgical billing team
The global obstetric package bundles antepartum care, delivery and postpartum care into one payment after delivery. That creates a long receivable and a set of rules about what falls outside it: visits for unrelated problems, high-risk services, ultrasounds, additional procedures at delivery, and what happens when the patient transfers in or out mid-pregnancy or changes insurance. Practices that bill the global without tracking those exceptions leave a lot of care unpaid.
Gynecology is procedural office and surgical billing: in-office procedures with same-day visits, contraceptive devices with product and insertion lines, hysteroscopy and laparoscopy with bundling rules, and a payer mix heavy with Medicaid and its state-specific family planning rules.
VisMed opens a case per pregnancy that tracks the global and everything outside it, and runs gynecology as an office procedure practice with device, bundling and Medicaid rules applied per plan.
Where ob/gyn practices lose money
The patterns we find in the aging and denial history before anything else changes.
Services outside the global unbilled
Problem visits unrelated to pregnancy, high-risk management, additional ultrasounds and procedures at delivery are separately billable and commonly absorbed into the package.Transfers and insurance changes
When care transfers or coverage changes mid-pregnancy, the package splits into antepartum visits by count, delivery and postpartum, billed to the right payer for each period. Billed as a global, it is denied or paid to the wrong plan.Ultrasound components and frequency
Obstetric ultrasounds have specific codes by trimester and detail, with technical and professional components and payer frequency rules.Contraceptive devices
The device and the insertion are separate lines, and Medicaid plans have particular rules on family planning claims and supply reimbursement.Same-day visit and gyn procedure
Colposcopy, biopsies and device insertions with a separately documented evaluation support modifier 25. Undocumented, the visit is lost.
What we do differently for ob/gyn
Specialty-matched coders and a denials specialist, working inside your own system.
We open a case per pregnancy
Each pregnancy gets a case with the expected global, the visit count, every outside-the-global service and any transfer or coverage change, so the right claims go out at the right time.We hold ultrasound rules by code and payer
Trimester and detail codes with component billing by ownership and frequency limits per plan.We run devices and family planning per state
Product and insertion lines with Medicaid family planning rules per state and plan.We code procedures with the bundles applied
Office and surgical gyn procedures coded with modifier and bundling rules from the note and report.
What we bill
The procedure and code families your account team already works in.
OB/GYN billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
What can we bill outside the global obstetric package?
Visits for problems unrelated to the pregnancy, high-risk services beyond routine antepartum care, ultrasounds, and procedures at delivery beyond the delivery itself, among others. VisMed tracks each pregnancy as a case so these are billed as they happen rather than absorbed.
What happens when a patient changes insurance during pregnancy?
The package splits. VisMed bills antepartum visits by count to the plan that covered them, and the delivery and postpartum care to the plan in effect then. The case tracks the dates so each claim goes to the right payer.
How does VisMed handle contraceptive devices under Medicaid?
Device and insertion as separate lines, with each state’s and plan’s family planning rules applied, including supply reimbursement and any required modifiers.
Can VisMed bill our ultrasounds?
VisMed codes obstetric and gynecological ultrasound by trimester and detail, with technical and professional components by ownership and the payer’s frequency rules held per plan.
How does VisMed bill high-risk pregnancy care?
The additional visits, monitoring and consultations that high-risk management requires are billable beyond the routine antepartum count when documented as such. VisMed flags a pregnancy as high-risk in the case at diagnosis and captures those services as they occur rather than letting them fall into the package.
Also in surgical
General surgery
Global-period tracking and assistant-at-surgery claims.
Orthopedics
Fracture care, implants and DME.
Neurosurgery
Multi-level procedures and co-surgeon billing.
Vascular surgery
Office-based labs and imaging supervision.
Thoracic surgery
Complex globals and critical-care overlap.
Plastic surgery
Reconstructive vs cosmetic separation.
Oral & maxillofacial surgery
Medical and dental claims on one case.
ENT
In-office procedures, audiology and allergy.
Ophthalmology
Eye-code vs E/M choice, injections and ASC.
Urology
Lithotripsy, in-office procedures and pathology.
Ambulatory surgery centers
Facility claims, implants and payer-specific groupers.
Anesthesia
Time units, modifiers and medical direction.
All specialties
The full list, in six groups
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Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
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