Possible Revenue Often Overlooked:
Getting Paid for High-Risk and Problem OBs
Published on Sat May 01, 1999
Some obstetrical patients require more visits, time and work from the ob/gyn practice than would be usual. How can this patient be financially recognized? Many ob/gyn practices do not realize that they are entitled to receive increased reimbursement when providing additional visits outside of the normal global ob package, says Liza Green, RRA, CCS-P, Coding Compliance Specialist for the John C. Lincoln Health Network in Phoenix, Arizona. In addition, Green points out that many ob coding professionals dont understand how to code and bill for high-risk or complicated obstetrical care.
Routine Global OB Care
Prior to understanding how to bill for complicated ob cases, the coding professional should be aware of the services that are considered part of the normal ob global package in codes 59400, 59510, 59610 and 59618. Based on CPT definitions, antepartum visits include such elements as reviewing the patients history, performing the physical exam, monitoring the patients blood pressure and weight, assessing the fetal heart tones, and checking routine urinalysis. The usual schedule of visits for the uncomplicated case includes a monthly ob visit up to the 28th week, biweekly visits to 36 weeks gestation, and weekly visits thereafter until the patient delivers (13 visits on average with a range of 10 to 15 total antepartum visits). Postpartum (also called puerperium) care includes hospital and office visits following delivery. Once discharged from the hospital, most patients only require one postpartum visit at four to six weeks after delivery. When a patients condition requires more visits, the CPT states these additional visits or services should be coded separately and, according to Green, practices should expect to be paid for these extra services.
Coding for Complicated Care
A number of conditions might complicate a patients antepartum or puerperium periods, such as gestational diabetes, preeclampsia, hyperemesis, pre or postpartum bleeding, premature rupture of membranes, fetal distress or infections. These conditions often require more work and exceed the global package. But the extent to which this will occur is often not fully calculable until after the delivery. Therefore, many ob offices will wait until that point and take a look at all the services provided during the antepartum and/or postpartum period before submitting any claims.
Once a global period for any ob patient is complete, a practice should have a system for carefully reviewing the patient records to ensure that any charges beyond the global are coded and billed. According to Green, this is an area of lost revenue in many ob/gyn practices.
Once these services are found, they should be coded and billed, using the appropriate Evaluation and Management (E/M) or Medicine CPT codes, based on the care provided at the visit. The ICD-9 diagnosis codes linked on the HCFA-1500 claim [...]
