Ob-Gyn Coding Alert

Pregnant patient transfer may still mean reporting a global code.

You know that you should report antepartum care codes based on the number of visits your ob-gyn performs. Think a third-term new patient puts you in individual codes? You might still be able to use the global ones.

When a patient transfers to your ob-gyn practice late in her pregnancy, your first task is to determine if she has received any antepartum care elsewhere, the American Congress of Obstetricians and Gynecologists (ACOG) recommends. Here’s how to decide whether to code visits individually or globally.

Report Individual Codes for Previous Care

If a patient has received antepartum care from another physician, you will not be able to report the global ob code (59400, 59510, 59610, or 59618). 

Instead, you will have to separately report the antepartum care (59425-59426), delivery (59409-59410, 59514-59515, 59612-59614), and postpartum care (59430) if you are not allowed to bill the delivery plus postpartum codes. If the ob-gyn performs the delivery and postpartum care, CPT® includes 59430 in the delivery with postpartum care code.

The physician who provided the initial antepartum care will bill separately for his services. Consequently, if you bill the global in this case, you would be reporting some antepartum care that you did not perform.

Use Global When Transferee Has Not Had OB Care

On the other hand, if the patient did not receive any antepartum care before coming to your practice, you may be able to report the global code. The physician may perform all the global ob package components in a short time because CPT® doesn’t specifically require a minimum number of antepartum visits to report this service. Note, however, that given CPT®’s definition of the timing for routine antepartum visits, most payers consider 13 visits the norm.

Check policies: Some carriers do require an established number (this ranges from 8-15 over the various payers) of antepartum visits before you can submit the global ob code(s). If your ob-gyn performs substantially fewer visits than the payer normally requires for the global package, you may have to report the global ob code appended with modifier 52 (Reduced services).