Global obstetric package

March 21st, 2009 - Codapedia Editor
Categories:   Coding   Specialty Coding  
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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.

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