# modifier - global period



## alisan (Mar 11, 2013)

Our office was treating a pregnant patient and she has left the practice. We are trying to bill the appropriate E & M code but they rejected stating "global period". Does anyone know what modifier to use? Thanks!


----------



## Thouvenel (Mar 11, 2013)

You don't need a modifier, but you do need to appeal the decision to the insurance company.  In the appeal state how many times the patient was seen and you are not billing for the global period as the patient left the practice.  You may need to send the office notes.


----------



## kvangoor (Mar 12, 2013)

It is weird that you would get a global rejection if you did not bill any antenatal or delivery codes. If the patient was seen more than 3 times, I would use 59425-6 only. Any other visits unrelated to management of pregnancy would need a 24 modifier.


----------



## Thouvenel (Mar 12, 2013)

The 59425 is for visits 4 through 6, the first 3 antepartum visits still have to be billed out as E/M codes.  I bill out the visits as:

99214  5/20/12   V22.0
99212  6/19/12   V22.0
99212  7/19/12   V22.0
59425   10/09/12   V22.0

Most of the times, these claims are not easily paid.  An appeal usually is required, but it is very easy to explain the circumstances to get paid.


----------



## huntersmum (Mar 15, 2013)

*Huh???*

I have always been led to believe that the first three visits are included in the 59425...is this incorrect?  You could read the cpt book either way now that I look at it that way???


----------



## huntersmum (Mar 15, 2013)

*never mind*

above it this say for antepartum care only, bill 59425, 59426 OR e/m.


----------



## Thouvenel (Mar 15, 2013)

I you look in the CPT book under the exclusions for 59425-59430, it excludes antepartum care 1-3 visits (99201-99499).  So, you need to bill out the first three visits.


----------



## TYSON1234 (Mar 15, 2013)

Pt was seen 4 times, you would bill 59425. The CPT book states whether they have 1,2 or 3 visits you would bill the proper E/M code anything after you would either bill the 59425/59426 (depending on the total # of visits).


----------



## Emmy1260 (Mar 19, 2013)

Please refer to CPT Assistant August 2002.

59425: antepartum care only; 4-6 visits, is reported with 4 to 6 antepartum care visits are provided.

Example provided states the physician providing at least 4 and up to 6 antepartum care visits would bill only 59425.


----------



## Thouvenel (Mar 19, 2013)

Thanks for all the corrections!


----------



## tlaubhan (Apr 22, 2013)

I was wondering if anyone can send me or direct me to a OB/GYN worksheet. 

Thanks, Tami 

email address is:   tamara.laubhan@hma.com


----------

