OB/GYN Coding Audits That Find What You Are Missing
The average OB/GYN practice loses 15–30% of collectable revenue to coding errors. Our certified auditors find the missed codes, fix the modifier errors, and eliminate the OIG exposure — with a written corrective action report in 14 business days.
Six Types of OB/GYN Coding Audits
Different practice situations call for different audit approaches. We recommend the right type for your specific risk profile.
Prospective Audit
Claims reviewed BEFORE submission. Catches coding errors before they become denials or compliance exposure.
- ✓Zero denial risk on audited claims
- ✓Immediate revenue optimization
- ✓Real-time coder education
Retrospective Audit
Claims reviewed AFTER submission and payment. Identifies patterns in past billing for correction and recovery.
- ✓Identifies systemic errors
- ✓Recovery opportunities on underbilled claims
- ✓Compliance documentation
E/M Coding Audit
Focused review of Evaluation & Management codes (99202–99215) against 2024 AMA MDM guidelines.
- ✓MDM documentation alignment
- ✓Level optimization
- ✓OIG risk reduction
Surgical Coding Audit
Review of procedure codes, modifiers, and operative report documentation for all GYN surgical cases.
- ✓Modifier error elimination
- ✓Bundling rule compliance
- ✓Operative report documentation review
Modifier Usage Audit
Analysis of modifier application patterns across all claim types — identifying both missing and incorrect modifiers.
- ✓Modifier matrix development
- ✓Denial root cause resolution
- ✓Correct unbundling documentation
Charge Capture Audit
Review of the entire charge capture workflow from clinical encounter to claim submission. Identifies dropped charges.
- ✓Zero dropped charges
- ✓Workflow optimization
- ✓Staff training targets
E/M Coding Changes — Are You Still Billing Under Old Rules?
The 2024 AMA E/M revision changed how visit complexity is determined. Practices still coding by history/exam bullet counts are systematically underbilling.
Upcoding vs Undercoding — Both Cost You
Upcoding
Billing a higher-level code than documentation supports. Less common than undercoding, but far more dangerous.
- ✗OIG civil investigation
- ✗False Claims Act liability
- ✗CMS exclusion from Medicare/Medicaid
- ✗Mandatory repayment + penalties
- ✗State medical board review
Undercoding
Billing a lower-level code than documentation supports. The most common coding error in OB/GYN — costing practices 15–30% of collectable revenue.
- →99213 billed when 99214 supported
- →Missing modifier 22 on complex surgery
- →59430 postpartum never billed
- →No J-code for IUD alongside 58300
- →LARC counseling codes omitted
Top OIG Audit Targets in OB/GYN Billing
We audit for every OIG work plan priority relevant to OB/GYN — finding and fixing issues before federal auditors do.
How Our Coding Audit Works
6 steps from record request to corrective action report — completed in 14 business days.
Record Request
We request a random statistical sample of 20–50 claims from the audit period — enough for statistical significance without operational burden.
Documentation Review
Our CPC-OB certified auditors review each claim against the underlying clinical documentation in your EHR.
Code Comparison
Billed codes are compared against audit-correct codes. Discrepancies are categorized: undercoded, overcoded, modifier error, missing code, or documentation gap.
Error Rate Calculation
We calculate your error rate by category. An error rate above 5% on any category warrants a corrective action plan.
Revenue Impact Analysis
We quantify the revenue impact of identified errors — both missed revenue (undercoding) and overpayment risk (upcoding).
Corrective Action Report
You receive a written report with specific findings, recommended code corrections, education priorities, and a 90-day corrective action plan.
Our Audit Team Certifications
Coding Audit Questions
Find Out What Your Coding Errors Are Costing You
Get a free coding audit assessment — we'll review a sample of your recent claims and identify your highest-risk coding areas at no charge.