{"id":28941,"date":"2026-04-02T12:30:00","date_gmt":"2026-04-02T12:30:00","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=28941"},"modified":"2026-04-02T12:37:46","modified_gmt":"2026-04-02T12:37:46","slug":"are-global-period-gaps-costing-your-ob-gyn-practice","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/are-global-period-gaps-costing-your-ob-gyn-practice\/","title":{"rendered":"Are Global Period Gaps Costing Your OB-GYN Practice?"},"content":{"rendered":"
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Yes\u2014global period gaps are costing your OB-GYN practice $830,880 per 12 months when global maternity packages bundle services that should bill separately, post-global encounters get written off incorrectly, and diagnostic ultrasounds go unbilled despite payer contracts allowing separate payment.<\/strong><\/p>\r\n<\/div>\r\n<\/div>\r\n

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Your practice loses $1,680 per high-risk pregnancy, $420 per post-global visit, and $1,840 per complication requiring diagnostic imaging\u2014creating systematic revenue leakage invisible in standard denial reports because these services never enter the billing system.<\/p>\r\n<\/div>\r\n<\/div>\r\n

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The 60-Second Global Period Test<\/h2>\r\n<\/div>\r\n<\/div>\r\n
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Pull last month’s delivery count. Multiply by $4,200 (average global package payment).<\/p>\r\n<\/div>\r\n<\/div>\r\n

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Now pull last month’s actual maternity collections.<\/p>\r\n<\/div>\r\n<\/div>\r\n

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Table 1: What Your Gap Reveals<\/strong><\/p>\r\n<\/div>\r\n<\/div>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Expected vs. Actual<\/strong><\/td>\r\nWhat’s Happening<\/strong><\/td>\r\nLoss Per 12 Months<\/strong><\/td>\r\n<\/tr>\r\n<\/thead>\r\n
Within 5%<\/td>\r\nAccurate global billing<\/td>\r\nMinimal loss<\/td>\r\n<\/tr>\r\n
15\u201325% gap<\/td>\r\nModerate unbundling failures<\/td>\r\n$180,000\u2013$420,000<\/td>\r\n<\/tr>\r\n
25\u201340% gap<\/td>\r\nSevere global period confusion<\/td>\r\n$420,000\u2013$960,000<\/td>\r\n<\/tr>\r\n
40%+ gap<\/td>\r\nCritical coding chaos<\/td>\r\n$960,000\u2013$1,800,000+<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

If actual collections are 15%+ below expected, global period gaps are destroying revenue.<\/p>\r\n

Three Global Period Gaps Destroying OB-GYN Revenue<\/h2>\r\n

\"Three<\/p>\r\n

Gap 1: High-Risk Services Billed as Global When They’re Separately Payable ($362,880 Loss)<\/h3>\r\n

The $1,680 per pregnancy gap:<\/strong><\/p>\r\n

Patient has gestational diabetes requiring weekly monitoring, insulin management, and fetal surveillance.<\/p>\r\n

Standard global package (59400): Covers routine prenatal, delivery, postpartum for $4,200.<\/p>\r\n

What gets billed:<\/strong> 59400 only.<\/p>\r\n

What should bill separately:<\/strong><\/p>\r\n

Weekly NSTs (59025): $85 \u00d7 12 weeks = $1,020<\/p>\r\n

Insulin management (99211-99214): $140 \u00d7 8 visits = $1,120<\/p>\r\n

Diabetes education (98960): $180 \u00d7 2 sessions = $360<\/p>\r\n

Total unbilled services:<\/strong> $2,500 minus global package credit = Net additional $1,680<\/strong><\/p>\r\n

Why OBGYN Billing Services miss this:<\/strong><\/p>\r\n

Billing staff see pregnancy, automatically code global package, never review chart for separately billable high-risk services.<\/p>\r\n

Payer rules most practices miss:<\/strong><\/p>\r\n

Services for pre-existing conditions<\/strong> or pregnancy complications<\/strong> are separately billable even during global period when:<\/p>\r\n

Condition existed before pregnancy (chronic hypertension, diabetes)<\/p>\r\n

Complication develops requiring management beyond routine care (preeclampsia, IUGR)<\/p>\r\n

Separate diagnosis code supports medical necessity<\/p>\r\n

Real practice volume:<\/strong><\/p>\r\n

Monthly deliveries: 45<\/p>\r\n

High-risk pregnancies: 18 (40%)<\/p>\r\n

Average separately billable services per high-risk case: $1,680<\/p>\r\n

Monthly unbilled:<\/strong> 18 \u00d7 $1,680 = $30,240<\/p>\r\n

Loss per 12 months:<\/strong> $362,880<\/p>\r\n

The Chart Flag Fix:<\/strong><\/p>\r\n

Create EHR alert triggered by diagnosis codes O24 (gestational diabetes), O10-O16 (hypertensive disorders), O36.5 (poor fetal growth), O42 (premature rupture of membranes).<\/p>\r\n

Alert displays: “High-risk pregnancy\u2014review for separately billable services beyond global package.”<\/p>\r\n

Specialized OBGYN Billing Services<\/strong><\/a> implement these diagnosis-triggered protocols preventing automatic global bundling when complications support separate service billing.<\/p>\r\n

Recovery:<\/strong> Captures $363,000 per 12 months in previously bundled services.<\/p>\r\n

Gap 2: Post-Global Services Incorrectly Written Off ($70,560 Loss)<\/h3>\r\n

The global period rule:<\/strong> 59400 includes routine postpartum care through 6 weeks (42 days) post-delivery.<\/p>\r\n

The gap:<\/strong> Patient returns Day 58 with postpartum complications. Billing writes it off as “still in global period.”<\/p>\r\n

Wrong.<\/strong> Global period ended Day 42. This is separately billable.<\/p>\r\n

What gets missed:<\/strong><\/p>\r\n

Patient Day 52: Postpartum depression screening (96127) = $32<\/p>\r\n

Patient Day 58: Endometritis evaluation (99213) = $140<\/p>\r\n

Patient Day 65: LEEP procedure for abnormal Pap (57522) = $380<\/p>\r\n

Total unbilled:<\/strong> $552 per patient with post-global visits<\/p>\r\n

Why Medical Billing Services miss this:<\/strong><\/p>\r\n

EHR shows “recent delivery”\u2014billing assumes still global, doesn’t verify exact day count.<\/p>\r\n

The day-count calculation:<\/strong><\/p>\r\n

Global period = Day of delivery + 42 days postpartum<\/p>\r\n

Delivery April 1 = Global period ends May 13 (42 days later)<\/p>\r\n

Visit May 20 (Day 49) = Separately billable (7 days past global)<\/p>\r\n

Real practice volume:<\/strong><\/p>\r\n

Monthly deliveries: 45<\/p>\r\n

Patients with post-global visits: 14 (31%)<\/p>\r\n

Average unbilled per patient: $420<\/p>\r\n

Monthly loss:<\/strong> 14 \u00d7 $420 = $5,880<\/p>\r\n

Loss per 12 months:<\/strong> $70,560<\/p>\r\n

The Calendar Alert Fix:<\/strong><\/p>\r\n

When delivery coded, system auto-calculates global end date (delivery date + 42 days).<\/p>\r\n

Any encounter after that date triggers alert: “Post-global visit\u2014billable separately. Do not bundle.”<\/p>\r\n

OBGYN Billing Services<\/strong> with calendar automation prevent systematic post-global bundling errors costing $70,560 per 12 months.<\/p>\r\n

Recovery:<\/strong> $70,560 per 12 months from post-global visit capture.<\/p>\r\n

Gap 3: Ultrasounds Bundled When Payer Allows Separate Payment ($397,440 Loss)<\/h3>\r\n

The wrong assumption:<\/strong> All prenatal ultrasounds are included in global package.<\/p>\r\n

The reality:<\/strong> Diagnostic ultrasounds for complications are separately billable for most commercial payers.<\/p>\r\n

Routine anatomy scan (76805):<\/strong> Included in global\u2014do NOT bill separately<\/p>\r\n

Diagnostic scans (separately billable):<\/strong><\/p>\r\n

Growth scan for IUGR (76816): $280<\/p>\r\n

Biophysical profile (76818): $320<\/p>\r\n

Fetal echocardiogram (76825): $480<\/p>\r\n

Real scenario:<\/strong><\/p>\r\n

Patient with placenta previa requires:<\/p>\r\n

Monthly growth scans (76816): $280 \u00d7 3 = $840<\/p>\r\n

Weekly biophysical profiles third trimester (76818): $320 \u00d7 8 = $2,560<\/p>\r\n

Total separately billable ultrasounds:<\/strong> $3,400<\/p>\r\n

What gets billed:<\/strong> $0 (staff assumes “included in global”)<\/p>\r\n

Payer variance (critical for RCM Services):<\/strong><\/p>\r\n

Medicare:<\/strong> Most ultrasounds bundled in global<\/p>\r\n

Commercial (UnitedHealthcare, Aetna, Blue Cross):<\/strong> Diagnostic ultrasounds separately billable when:<\/p>\r\n