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)

How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam
April 12th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...
Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K
April 12th, 2021 - Wyn Staheli, Director of Research
Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.
Properly Reporting Imaging Overreads (Including X-Rays)
April 8th, 2021 - Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research
hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.
How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment
March 31st, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
Understanding Skin Biopsy Codes
March 23rd, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...
How Reporting E/M Based on Time May Lose Money
March 18th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
COVID-19 Vaccines
March 10th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...



Home About Contact Terms Privacy

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

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association