# Global Maternity Package



## dalila10 (Oct 4, 2015)

Hi, I have been confronted with an issue of when maternity packages are not considered a package. There was a patient who was pregnant and in between that time her insurance changed. I billed this out to he insurance as Antepartum for the old insurance and when she delivered she had 5 visits before she delivered so I billed out the antepartum visits for the 5 visits w/ new insurance and then the delivery only code including her postpartum. I was told this was wrong. Please clarify and tell me if I was right is there something in writing regarding correct billing for unbundling


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## ciarahertzog (Oct 5, 2015)

How you described it was exactly how we would have billed it too.  It probably matters what insurance company the patient had at the time of delivery.  Some insurance companies allow different numbers of total visits when it comes to billing globally [CPT says 13-15 but some will let you bill a global 59400 with as few as 7 visits before delivery; and the Medicaid plan we accept tells us to bill globally after 3 visits].  Perhaps they want you to bill the global code even though she has only had 5 visits.  Or maybe they don't want you to bill the "delivery with postpartum" code because you haven't performed her 6 week postpartum visit yet.  
You will probably have to talk to that insurance company to see what their individual policy is for number of visits included in the global period.


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## CMPM12 (Oct 8, 2015)

This is not wrong, my first suggestion is to read your insurance contracts on how they want you to bill. You cannot bill out global codes 59400, 59510 etc.. if the patient changed insurance plans during her pregnancy.... unless the insurance carrier allows you to (which I have not come across any)  The way you billed is correct. 

It is global when the patient presents to your office without prior care and depending on the amount of visits the patient has, insurance contracts will differ with the amount of routine visits you need to bill out Global. If the patient is seen prior to seeing your physician you are required to split up the global. 

 Here is part of an article from ACOG regarding these two scenarios:
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Coding when a patient changes insurance:

When a patient changes insurance you need to report those services that occurred during the effective dates of the old insurance to the old insurer and those services that occurred under the new insurance to the new insurer. 

This means that you will have to separate the global and bill the antepartum visits, delivery and postpartum care separately. 

You should check with the insurer to see how they want you to report in these cases.  Some may still allow you to bill the global to the new insurer.  This will depend on the insurer and what the circumstance was for the change of the insurance (such as the employer switching their insurance

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Coding when a patient transfers to your practice late in the pregnancy:

When a patient transfers to your practice late in her pregnancy, you first need to determine if she has had antepartum care elsewhere.  If the patient has had care elsewhere, then you will not be able to report the global and will need to report the antepartum care, delivery and postpartum care separately.  The physician that had been providing the antepartum care would bill for the services that he/she performed.  Therefore, if you billed the global, you would be billing for some antepartum care that you did not perform.

If the patient did not have any antepartum care prior to coming to your office you may potentially be able to report the global.  In this case, the physician may actually perform all of the components of the global package in a short time.  There isn?t a certain number of antepartum visits required to report the global.  However, some insurers do require that a certain number of antepartum visits be performed before the global can be reported.  If the visits are substantially less than that normally performed for the global OB package, the physician may choose to report a modifier 52 (reduced services) with the global code. 

You should check with the insurer to see how they want you to report in these cases.  It is best to get the information in writing.


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## nucarolyn (Oct 26, 2015)

*new to OBGYN*

Thank you CMPM12 for the information.  I'm fairly new to OBGYN and get conflicting info on what is allowed with deliveries and on certain gyn surgeries.  I plan on taking the obgyn specialty exam before Feb 2016, any suggestions and/or advice would be greatly appreciated. 

Carol


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## lindaorr (Nov 18, 2015)

Study Urogyn and gyn it has alot of that, some ob stuff also but alot of things for gyn women, it did have ob questions but I thought they were easy because that is what I do ob/gyn.  our doctors don't do alot of urogynocology so I had to study alot. I did pass the test and happy about that so be prepared and get ready for alot of reading.


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