Ob-Gyn Coding Alert

Coding expert offers surefire advice for your obstetric coding questions

Reporting obstetrics may be something you do every day, but that doesn't mean it's easy.
 
Accurate, authoritative answers to troublesome coding questions will help you avoid costly errors that lead to low reimbursement or claims denials.
 
The following questions were raised by ob-gyn coders across the country and answered by Melanie Witt, RN, CPC, MA, who provides the answers based on her experience as an independent coding education consultant and former American College of Obstetrics and Gynecology (ACOG) program manager for its coding education department.
 
What's Included in the Ob Package? Question: What services are considered part of the global maternity package (for example, routine dip urinalysis, blood draw, etc.)? CPT includes a definition of services that are part of  the global package in the "Maternity Care and Delivery" section immediately before 59000. The guidelines explain what is included in antepartum, delivery and postpartum services.
 
Many coders are confused because some payers may try to include some of the tests performed as screening during pregnancy in the global package. The CPT definition states that a routine chemical urinalysis is included - it does not specify a dipstick, and it does not specify under microscopy or another method. The definition simply states that a routine urinalysis is included, and this is a chemical test. If that is what you are doing, regardless of the method used, it is included in the obstetric global package.
 
Any other test that the ob-gyn performs on a patient during her pregnancy is most likely excluded from the global package under CPT guidelines. There may be complications, however. For example, a physician was getting very nervous because he had been sued previously, so he decided to do an alpha-fetoprotein (AFP) test on all pregnant patients. The insurance carriers saw the AFP being billed regularly for all patients and notified the physician that they were no longer going to reimburse for that service. They stated that the AFP was now recognized as part of his routine obstetric package care, and they were rolling it in. Unfortunately, this is the view of many payers.
 
If you consistently bill for things when there appears to be no good medical indication for the particular patient, the insurer will tend to view the service as part of your global package and refuse to pay for it. You are not performing the service because the patient needed it; you are doing it on all patients, regardless of need. Ensure that the tests you do outside of the routine urinalysis are medically indicated for the specific patient.
 
Drawing blood to send a sample to the laboratory is not included as part of your global service. [...]