Ob-Gyn Coding Alert

You may have to apply this modifier to global ob codes.

Now that the stay-at-home orders are being lifted, your ob-gyn practice may experience an influx of pregnant patients who resisted coming into your office for either their preliminary or regular antepartum visits. That means you have to know how to report ob-gyn cases where your ob-gyn sees global ob packages with less antepartum visits than normal. Here’s what to do.

Use Global When Patient Has Not Had OB Care

Suppose a patient comes into your office for the first time in her pregnancy, and she’s already second trimester.

If the she did not receive any antepartum care before coming to your practice, you may be able to report the global code (59400, 59510, 59610, or 59618). 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).

Report Individual Codes for Previous Care

On the other hand, suppose a patient has received antepartum care from another physician (such as via telehealth) but now she wants to see your ob-gyn in person.

In this instance, you may not be able to report the global ob code (59400, 59510, 59610, or 59618), says Peggy Stilley, CPC, CPC-I, CPMA, CPB, COGBC, Senior Education Specialist for the AAPC.

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.