Ob-Gyn Coding Alert

Question: I’ve been asked to compile a list of conditions that would not be considered part of the “global maternity package” that our ob doctors can bill for. I’m pretty sure there is no list that includes “all” of the conditions, but does anybody know of a good site/book where I can at least get an idea? I know that for the most part the condition(s) cannot be pregnancy-related.

Michigan Subscriber

Answer: Each payer decides which, if any, conditions would be considered high risk, and even then billing outside of global will usually be denied at the time you submit the claim — unless the condition is not pregnancy related.

Your providers must decide which visits are truly outside of routine global care and document and bill accordingly, and the payer will pay or deny based on their policy. If they deny them, you can then appeal after delivery. Remember that many times, the provider is ordering testing (which is getting paid separately) but not actually seeing the patient more often when the testing shows no problem has developed.