# ob E&M



## chewri (Apr 20, 2011)

When a pregnant patient comes in for a acute problem during the global problem and a E&M service was billed what modifier should be used? 24 or 25?


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## tmerickson (Apr 20, 2011)

If the problem is not pregnancy related, or is not a routine pregnancy problem, then you would just bill the office code without any modifer.  Just make sure the diagnosis codes support medical necessity.


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## MEDASSURE (Apr 27, 2011)

I use the modifier "GB"  "not included in the global maternity package"


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## hthompson (May 2, 2011)

Hey correct me if I'm wrong because I'm here for OB coding questions myself, but isn't GB for "Claim being REsubmitted for payment because it is NO LONGER covered under a global payment demonstration".

Doesn't that mean that it was a denied procedure, rather than a new claim being submitted?


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## m.j.kummer (May 2, 2011)

Straight from ACOG -
For Non-Pregnancy Visits:
– Physician must document components of visit on separate progress not (NOT on OB flow sheet)
– Physician must state that condition IS NOT related to OB 
– A non-pregnancy diagnosis code must be linked to the problem visit
– It's optional to append secondary diagnosis code, V22.2 (Pregnant state, incidental)


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## ksimpson (May 7, 2011)

*Instructions for using modifier GB*

I'm really interested in learning the correct use of this modifier. Can it be used when a pregnant patient changes physician or insurance coverage, in order to indicate that the payer won't be billed a global charge ? This modifier has been around since 2002 but I don't see it used that often. Anyone have any instructions for use ?


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## MEDASSURE (May 12, 2011)

*Gb modifier*

I am an OB/GYN biller and use the GB modifier often.  There are many times we are seeing a pregnant patient who then decides, for whatever reason (moving, etc) to switch to another office.  All of her antepart visits are suppose to be included in the delivery.  Now that we will no longer be delivering her baby, all the antepartum visits are billable individually.  It is in these cases that I use the GB modifier appendend to all the antepartum visits.  It still sometimes requires a call to the insurance company, but for the most part they are now aware these visits are not included in the global maternity package.  I don't have documentation that states it is for "rebilling" a procedure not included in the global maternity package. 

Hope this helps!


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## ksimpson (May 18, 2011)

*GB Modifier*

I work for a payor and I'm trying to add this info to our current ob payment policy instructing providers to bill using the GB modifier when the provider will no longer bill a global service. I need some sort of documentation supporting using this modifier for this situation. I searched CMS but was unable to locate any info, any help is appreciated.


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## MJ4ever (May 18, 2011)

MEDASSURE said:


> I am an OB/GYN biller and use the GB modifier often.  There are many times we are seeing a pregnant patient who then decides, for whatever reason (moving, etc) to switch to another office.  All of her antepart visits are suppose to be included in the delivery.  Now that we will no longer be delivering her baby, all the antepartum visits are billable individually.  It is in these cases that I use the GB modifier appendend to all the antepartum visits.  It still sometimes requires a call to the insurance company, but for the most part they are now aware these visits are not included in the global maternity package.  I don't have documentation that states it is for "rebilling" a procedure not included in the global maternity package.
> 
> Hope this helps!





As far as I remember, but haven't had this scenario, there are CPT codes that some up the total visits the patient was seen and you only bill one of these. But it may have changed or is different per payor.


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