According to coding experts, one of the most frequently asked questions about
ob-gyn coding is routine global obstetric billing. The concept is simple: rather than breaking apart charges for each service and procedure involved in a pregnancy, antepartum care, labor and delivery and postpartum care are bundled together into one charge. The question comes in knowing what exactly is and is not included in the global codes.
Whats Included/Excluded in the OB Global?
In the CPT, under the section for Maternity Care and Delivery (59000-59899), there are four global codes for routine obstetric care, including antepartum, delivery and postpartum. The codes were designed to cover the differing work levels involved in four possible common obstetric scenarios:
59400 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care.
59510 - Routine obstetric care including antepartum care, cesarean delivery and postpartum care.
59610 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care after previous cesarean delivery.
59618 - Routine obstetric care including antepartum care, cesarean delivery and postpartum care, following attempted vaginal delivery after previous cesarean delivery.
According to Lydia Dollar, senior coding and reimbursement analyst and physician compliance officer at Bay State Medical Education and Research Foundation in Springfield, MA, while global codes are straightforward and most carriers and state Medicaid providers recognize them. However, the difficult part comes in knowing which procedures and services will be eligible for reimbursement. The best place to start is to first know what the CPT guidelines include and exclude in their ob global codes:
Included:
The initial patient history and examination, including recording of weight, vital signs and any counseling or advice provided about the pregnancy during the initial visit.
Monthly visits up to 28 weeks gestation to monitor ongoing progress, including examination, weight and vital sign monitoring, assessment of fetal heart tones, routine chemical urinalysis
Bi-weekly visits for examination and monitoring of pregnancy from 28 to 36 weeks gestation
Weekly visits for examination and monitoring of pregnancy from 36 weeks to delivery
Admission to the hospital for labor and delivery including admission history and physical examination
Management of uncomplicated labor
Routine fetal monitoring during labor
Ordering and administration by the attending
physician of medications during labor (e.g. Pitocin, pain control)
Artificial membrane rupture prior to delivery
Vaginal delivery including episiotomy, forceps, minor laceration repair and placenta delivery
Cesarean delivery including all the necessary routine surgical procedures
Postpartum care including hospital and office visits and any routine care following a vaginal or cesarean delivery
Excluded:
Charges for the initial testing for a unconfirmed pregnancy
Ultrasound testing
Fetal biophysical profile
Fetal echocardiography
Amniocentesis
Cordocentesis
Fetal non-stress [...]
