# Global OB Package



## Patricia Ferrer (Oct 14, 2008)

If the global ob package is for uncomplicated pregnancy with delivery & uncomplicated postpartum care, than how should we bill for any complications that require extra care, such as a gestational diabetic patient? Is it with a modifier or is it with a separate e/m code? Thanks for the input. 
Patricia at WHC


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## kbarron (Oct 15, 2008)

I would put modifier 22 on the delivery.


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## ARCPC9491 (Oct 15, 2008)

Anything above and beyond the "normal routine OB care" is billable with an E/M code.  Routine OB care is not "problem oriented" thats why they have the global code and don't use E/M codes for each visit. Gestational diabetes or any other issue would be problem oriented, so yes you can bill the E/M.


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## imjsanderson (Oct 31, 2008)

First I feel it depends on how many antepartum visits their were once delivered.  If you had more than the "usual" 13 visits you can bill each additional separately IF it was a true complication and only if the provider dictated/documented the visit.  When I bill deliveries and find more than 13 visits, I review each visit, pull out any with a complication code, review for documentation, and bill these with modifier -25 and the chart note.  Doesn't mean these will always get paid but it is appropriate billing.


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## Lisa Bledsoe (Oct 31, 2008)

It is my understanding that the "extra" visits need to be documented as non-routine and scheduled that way as well.


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## kbarron (Nov 3, 2008)

Is this anywhere in writing? We are having a discussion that states we can bill out E&M for pregnancy complications. I was always told that append modifier 22 and ask for higher reimbursement after delivery.


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## Lisa Bledsoe (Nov 4, 2008)

From what I have read, the -22 only applies to the delivery. CPT states it only applies to procedures, not E/M codes.  We code the non-routine complication of pregnancy visits with E/M codes and a complication ICD-9 and we do get paid.  We only use -22 if the delivery was an "increased procedural service".  You might want to look at the ACOG website for help on finding this.


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## kellysarg21 (Nov 10, 2008)

I agree with imjsanderson.  I am reading an ACOG book now "Procedural Coding in Obstetrics and Gynecology 2008".  If it is a pregnancy related complication then you would bill exactly as imjsanderson stated.  To quote this book exactly "Additional visits (over the usual 13) to treat complication of the pregnancy are reported after the patient has delivered.  These visits may be performed in the physician's office or in a facility (eg, patient is admitted to observation status or as an inpatient).  The additional visits for the complications must be linked to an appropriate diagnosis code.  examples of these conditions are gestational diabetes and placenta previa.  If the patient is admitted to observation or inpatient care and then delivers within 24 hours of the admission, the services are not reported."

If the conditions are not pregnancy related then they are reported at the time of service with and E/M code and the appropriate non-pregnancy diagnosis.  Examples are UTI, or URI.

I got this book from ACOG, sorry this post is so long, but thought it is what you needed.


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## Lisa Bledsoe (Nov 10, 2008)

*Additional visits*

That is very helpful.  Thank you.


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