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)

​​Polysomnography Services Under OIG Scrutiny
September 2nd, 2021 - Raquel Shumway
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?
Medicare Advantage - The Fastest Growing Government-Funded Program Undergoing Multiple Fraud Investigations
August 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Billing Dental Implants under Medical Coverage
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...
New Codes for COVID Booster Vaccine & Monoclonal Antibody Products
August 10th, 2021 - Wyn Staheli, Director of Research
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Chronic Pain Coding Today & in the Future
July 19th, 2021 - Wyn Staheli, Director of Research
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?
July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...



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