How to Avoid Global Maternity Billing Pitfalls: A Guide for OB/GYN Practices
When it comes to OB/GYN billing, global maternity billing is one of the most misunderstood and error-prone areas in revenue cycle management. From bundled services and varying payer policies to documentation oversights, even the most experienced providers can fall into common traps that lead to claim denials, payment delays, and revenue loss.
In this article, we’ll break down what global maternity billing includes, why it’s so complex, and most importantly how your OB/GYN practice can avoid costly mistakes.
The term “global maternity billing” refers to the use of CPT codes that bundle prenatal, delivery, and postpartum care into one comprehensive billing package. These include:
59400 – Routine obstetric care including antepartum care, vaginal delivery, and postpartum care
59510 – Routine OB care including cesarean delivery
59610 – VBAC (vaginal birth after cesarean) delivery
59618 – Attempted VBAC resulting in cesarean delivery
This global package covers services provided across an entire pregnancy episode usually from the first prenatal visit to 6 weeks postpartum (though some payers define different global periods).
Sounds simple? Not quite.
Why Global Maternity Billing Is a Common Pitfall
Despite being standardized in theory, real-world billing scenarios rarely fit neatly into the global model. Here’s why many OB/GYN practices struggle:
1. Incorrect Bundling or Unbundling
Some practices break up global codes and bill each prenatal visit separately resulting in denied claims or audits. On the flip side, practices may inappropriately bundle services that aren’t actually part of the global package (like high-risk pregnancy care or unrelated procedures).
2. Varying Payer Policies
Insurance companies don’t all play by the same rules. For example:
One payer may allow a 90-day postpartum period.
Another might only reimburse for 42 days.
Some require separate codes for high-risk care, while others include them in global billing.
Without payer-specific knowledge, you’re bound to face inconsistencies in reimbursement.
3. Lack of Detailed Documentation
Even if you use the right global code, failing to document what was done especially for additional services or complications can result in denials. Many payers want to see clear clinical justification if you bill outside the global code.
4. Mid-Pregnancy Transfers of Care
If a patient switches providers mid-pregnancy, billing the full global code may be inappropriate. Practices must then split the billing, often using:
59425 – 4–6 antepartum visits
59426 – 7+ antepartum visits
But without proper time/date tracking, this gets messy fast.
Best Practices to Avoid Global Maternity Billing Pitfalls
Here’s how OB/GYN practices can stay ahead of the curve and get paid correctly, the first time:
1. Know What’s Included in Global Maternity Care
Typically covered under global codes:
Initial and subsequent prenatal visits
Routine labs and fetal heart monitoring
Delivery (vaginal or cesarean)
Postpartum checkup(s)
Not included in global codes (and should be billed separately):
Complication management (e.g., gestational diabetes, hypertension)
Hospital visits before labor
Additional ultrasounds or diagnostic tests
Non-pregnancy related services (e.g., UTI treatment)
📝 Tip: Document and code these separately with appropriate modifiers (like 25 or 59) when necessary.
2. Understand Payer-Specific Global Periods and Rules
Create a payer matrix for your billing team that outlines:
Global period length (42 vs. 90 days)
Requirements for separate billing
Accepted codes and modifiers
Denial trends by payer
💡 Payer rules change frequently, especially with Medicaid stay updated!
3. Use the Right CPT Codes for Partial or Split Care
If you’re not providing full prenatal, delivery, and postpartum care:
Use 59425 or 59426 for partial antepartum care
Use 59409 or 59514 for delivery-only
Use 59430 for postpartum-only care
📆 Ensure accurate date ranges and total visits are documented clearly in the patient chart.
4. Train Clinical and Front Desk Staff on Billing Triggers
Most denials start with poor front-end processes. Make sure:
New patients are checked for prior OB visits or provider transfers
Front desk documents insurance authorizations at every stage
Providers note high-risk conditions in the medical record as they arise
👩⚕️ Your clinical team doesn’t have to be coders but they do need to flag anything outside the routine.
5. Outsource to OB/GYN-Specialized Billing Experts
If your team is stretched thin or doesn’t have OB-specific expertise, outsourcing your billing can dramatically reduce errors and denials.
A specialized OB/GYN billing partner will:
Assign AAPC-certified coders with OB experience
Stay ahead of payer updates and coding changes
Scrub claims for bundling errors or missing documentation
Provide prior authorization and denial management support
Track claim trends to optimize reimbursement
The Cost of Getting It Wrong
A denied maternity claim can cost:
$25–$50 in staff time to rework
Up to 90 days in delayed payments
Risk of underpayment for high-risk cases
1–3% of net OB revenue lost to unresolved denials
For practices delivering 300+ babies a year, that’s tens of thousands in preventable loss.
Final Thoughts: Get Paid for the Care You’re Giving
Global maternity billing shouldn’t feel like a guessing game. With the right structure, coding discipline, and documentation, your OB/GYN practice can minimize denials, get paid faster, and avoid compliance headaches.
If your team is struggling to keep up with billing changes or you suspect you’re underbilling now is the time to act.
Need support Navigating Global OB Billing?
Let our OB/GYN billing experts take the burden off your plate. We specialize in maternity coding, payer compliance, and revenue recovery.