A standard pregnancy bills one global code at delivery — 59400 for vaginal, 59510 for cesarean — covering antepartum care, delivery and six weeks postpartum. Money leaks when practices bill routine global visits separately, miss antepartum-only codes for transferred or switcher patients, and fail to separately bill unrelated problems with the right modifier during the global window.
The global package is a bundle, not a prohibition. Visits during pregnancy for unrelated conditions — an acute illness, an injury, a new medical problem — can be billed separately when documented as distinct services, with the appropriate modifier and diagnosis. What cannot happen is routine OB care billed piecemeal, which payers detect instantly and recoup. Our charge review distinguishes global-included care from separately billable encounters on every pregnancy account.
Split scenarios are where practices most often forfeit revenue. A patient who transfers care at 30 weeks, or delivers with a different practice, leaves pieces of the global package billable: antepartum-only codes 59425 (4–6 visits) or 59426 (7+ visits), delivery-only, or postpartum-only (59430) — each with its own rules about what was actually rendered. We reconstruct the episode from the chart and bill the correct fractional codes rather than defaulting to the global that will deny.
Beyond obstetrics, the well-woman workflow carries its own rules: Medicare screening pelvic examinations (G0101) paired with pap collection (Q0091), preventive visit splits from problem visits, and gynecologic procedures with their own global periods. We run all of it on one claim-scrubbing standard so the practice's highest-volume preventive work bills as cleanly as its deliveries.
“48% of leaders named denials and appeals their practice’s largest source of revenue leakage, compared with 23% who cited front-end issues.”