Most Common OB/GYN Billing Mistakes and How to Prevent Them

OB/GYN practices operate in a highly complex clinical environment. It is one of the practices that merges routine care, preventive screenings, high-risk pregnancies, surgeries, and comprehensive health services of women. This complex nature of OB/GYN practice comes with an equally complicated billing structure that practices struggle to manage consistently.

From modifier usage and global maternity billing to documentation gaps and payer-specific coding rules, OB/GYN claims are among the most frequently denied or underpaid in the healthcare system. That is why understanding the Most Common OB/GYN Billing Mistakes and How to Prevent Them is essential for maintaining sustainable revenue, improving claim acceptance rates, and avoiding compliance-related risks.

Let’s learn more about these billing mistakes and their prevention protocols for effective revenue cycle management.

Incorrect Use of Global OB Packages

One of the biggest OB/GYN billing errors involves misunderstanding global obstetric packages. Many practices mistakenly bill services separately that are already included within the global package, such as routine prenatal visits, postpartum care, and uncomplicated delivery services. On the other hand, some practices fail to separate services leading to the issues of underbilling. These services are supposed to be billed separately outside the global package. These services include high-risk pregnancy management, diagnostic ultrasounds, or problem visits during prenatal care.

Inconsistent Documentation for Procedures and Exams

Accurate documentation is highly important for successful OB/GYN billing. Procedures like colposcopies, biopsies, IUD insertion, laparoscopic surgeries, and postpartum procedures all have strict documentation requirements. In these documents, missing details such as site, method, justification, or time can lead to downcoding or denials. In addition to this, well-woman visits often get mixed up with preventive and problem-oriented care, and failing to separate these elements causes claim rejections or incorrect payments.

Incorrect Modifier Usage

Modifiers are crucial in OB/GYN billing due to the volume of procedures performed along with the other office visits. In this, common mistakes include misusing modifiers 25, 59, 76, and 51, which results in claim denials or reduced payments.

• • Modifier 25 should be used only when a significant, separately identifiable E/M service is performed on the same day as a procedure.
• • Modifier 59 is often misused and leads to payer audits if applied incorrectly.
• • Surgical modifiers for multiple procedures, bilateral services, or repeat procedures must be used cautiously and accurately.

Missing or Incorrect Diagnosis Codes

OB/GYN conditions often require highly specific ICD-10 codes. Many claims are denied because the diagnosis code does not support medical necessity or fails to accurately reflect the condition of a patient. The examples of such incidents include:

• • Using unspecified pregnancy-related codes
• • Applying generic codes for infertility
• • Omitting trimester-specific pregnancy codes
• • Not linking complication codes correctly

Errors in Preventive vs. Problem-Oriented Billing

Annual exams often highlight problems requiring diagnostic assessments. Many OB/GYN practices lose revenue by failing to differentiate preventive care (CPT 99381–99397) from problem-oriented visits billed separately. Payers frequently deny claims when the documentation does not clearly separate the preventive exam from the problem addressed.

Not Entering All Billable Services

OB/GYN offices often miss revenue simply because services are not entered or coded correctly. Common examples include:

• • Urinalysis
• • NST (non-stress test)
• • Endometrial biopsies
• • Contraceptive device supply + insertion
• • Ultrasound interpretations

When one procedure or visit is missed like forgetting to bill for the IUD device while billing only for the insertion, practices lose significant revenue.

Authorization and Eligibility Errors

OB/GYN care often requires preauthorization for ultrasounds, surgeries, infertility treatments, and high-risk pregnancy management. Claims get denied when:

• • Authorization numbers are missing
• • The authorization does not match the CPT code
• • Eligibility verification is incomplete

Failing to verify insurance for maternity benefits is especially expensive, as many payers have strict coverage limits.

Delays or Errors in Provider Credentialing

Many OB/GYN practices expand by bringing in new physicians, midwives, or nurse practitioners. But unless each provider is fully credentialed with payers, claims are held, denied, or pending for a longer period. This issue leads to:

• • Months of delayed revenue
• • Lost payments
• • Retroactive billing limitations

Using Provider Credentialing Services helps ensure new providers are enrolled, revalidated, and contracted efficiently, hence preventing challenges that disrupt revenue flow.

Lack of Regular Billing Audits

Without consistent audits, unnoticed errors accumulate and become long-term revenue loses. In OB/GYN practices, audits help in detecting:

• • Incorrect global package billing
• • Modifier misuse
• • Uncaptured procedures
• • Under-coded visits
• • Payer-specific compliance issues

Weak A/R Follow-Up

Even perfectly coded OB/GYN claims can face challenges in the payer system. Many practices lack the staff to conduct daily follow-ups, resulting in:

• • Growing accounts receivable
• • Missed appeal deadlines
• • Denials
• • Write-offs that could have been prevented

Frequently Asked Questions