Global obstetric package

March 21st, 2009 - Codapedia Editor
Categories:   Coding   Specialty Coding  
0 Votes - Sign in to vote or comment.

Payment for obstetrical services is packaged into a single payment when the physician practice provides all of the components of the service.  There are CPT® codes for each component, however, when the practice needs to bill only part of the service.  Physicians in a group of the same specialty are considered one physician, so it would not be appropriate to bill individual components when the entire service was performed by a single OB group.

The global OB package is defined in the CPT® book as including all of the care of an uncomplicated pregnancy, from the first prenatal visit, through delivery, until the postpartum visit.  According to CPT®, complications during pregnancy may be billed separately.

The OB package starts with the first OB visit: when the group begins the data collection and service.  It is not correct to bill that first visit with an E/M code, according to ACOG.  (American College of Obstetrics and Gynecology.)  If the patient comes in for a brief visit to confirm their pregnancy, that is separately billable.  However, with the availability of home pregnancy tests, most patients know they are pregnant, and call to schedule their first OB visit.  If the patient is scheduled for this OB visit, it is part of the global OB package and is not separately reimbursable.

The package includes the pre-natal visit monthly up to 28 weeks, biweekly until 36 weeks and weekly until delivery.  The weight, blood pressure, fetal heart tones, history, physical exam and routine chemical urinalysis are included in the package.  The history and physical performed when admitting the patient for delivery is part of the package, as well as management of uncomplicated labor and delivery. 

A physician practice may bill patients for some services outside the package.  A patient with complications, and requires more than the usual visits may be billed with office visits during the prenatal period.  Use the complication first (hypertension, etc) and the pregnancy diagnosis second for these visits billed outside the global package.  Bill these when they occur, not at the end of the delivery.

Can a practice be paid for seeing patients who present with a question of being in labor, but who are sent home?  Typically insurance companies will pay for these services if the patient does not delivery (because the H&P for delivery is part of the package) within the next 24-48 hours.  Payer policies vary.  What codes does the physician use? Typically, these patients have outpatient status, so the physician code will be either observation admission, or office/outpatient service.  Be very careful about billing for an observation admission: even the lowest level of observation admission requires a significant amount of documentation:  for the history: 4 HPI elements, 2-9 systems in the ROS, and all three of past medical, family and social history; for the exam: a detailed, 12 bullet exam (for the 1997 guidelines).  If the physician does not provide that level of service, bill only for an office visit.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Things to Consider Before Upgrading Medical Billing Software
August 11th, 2022 - Find-A-Code
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
How CMS Determines Which Telehealth Services are Risk Adjustable
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
OIG Investigates SCAN Health for Risk Adjustment Overpayments With Surprising Results
July 26th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We’ve seen a number of OIG risk adjustment data validation (RADV) audits recently where the independent review contractor was simply looking for any codes the payer reported that were not supported by the documentation, in an effort to declare an overpayment was made and monies are due to be repaid. However, it was refreshing to read this RADV audit and discover that the independent review contractor actually identified HCCs the payer failed to report that, while still resulting in an overpayment, was able to reduce the overpayment by giving credit for these additional HCCs. What lessons are you learning from reading these RADV audit reports?
Addressing Trauma and Mass Violence
July 21st, 2022 - Amanda Ballif
After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.
The 'Big 2' HIPAA Rules Medical Billing Companies Must Follow
July 20th, 2022 - Find-A-Code Staff
HIPAA covers nearly every aspect of how medical and personal information is collected, utilized, shared, and stored within the healthcare industry. Title II of the rules is applied directly to medical billing companies and independent coders. The 'Big 2' rules that medical billing companies must adhere to revolve around privacy and security.
The Beginning of the End of COVID-19-Related Emergency Blanket Waivers
July 19th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association