Ob-Gyn Coding Alert

Question: We now charge an evaluation and management (E/M) visit for the first ob visit and then bill the global fee at delivery. Is it ever acceptable to bill per ob visit and then the global? I am aware of the antepartum codes and we use these only for ob patients who leave our practice. Many times we will see our ob patients for more than the 13 visits usually considered part of global.

Arizona Subscriber

Answer: According to guidelines published by the American College of Obstetricians and Gynocologists, the first visit included in the global ob package is the one in which the ob record is initiated, although you may want to check with individual insurers for their particular guidelines. You may charge for extra ob visits at the time they occur if the patient is seen for something not related to the pregnancy. Also, if a patient is seen more than the typical number of times (13 antepartum visits) for other than a normal pregnancy (the patient is diabetic, for example), the total number of antepartum visits can be added together and any beyond the normal 13 can be billed at the end of the pregnancy. The physician will need to document these extra visits very carefully so the coder will know exactly how many extra visits took place, the reason(s) for the visits and the level of E/M service supported by the documentation.


Answers for Reader Questions provided by Melanie Witt, RN, CPC, MA, former program manager for the American College of Obstetricians and Gynecologists department of coding and nomenclature and an independent coding educator.