Ob-Gyn Coding Alert

Question: When ob patients are given Rhogam shots and 1 and 3 hr ggt (gamma glutamyl transferase), are these included in the global fee?

Karen Baron
Ossippee Tamworth Family Medical Center
Ossippee, N.H.

Answer: According to the American College of Obstetrics and Gynecology (ACOG), management of medical problems, inpatient or outpatient, not related to the pregnancy (e.g., pneumonia, diabetes, chronic hypertension), or management of inpatient or outpatient medical problems that are related to the pregnancy, including pre-term labor, bleeding, pregnancy-induced hypertension, etc., are considered separate services not included in the global maternity package. Therefore, they can be billed as stand-alone charges, separate from the global delivery charge.

ACOGs definition of global maternity package also states that laboratory tests, not including dipstick urinalysis, are excluded, along with the venipuncture (36415, routine venipuncture or finger/heel/ear stick for collection of specimen[s]) and may be billed separately. The administration of Rhogam shots is listed by ACOG as one of the services excluded and billed separately from the global maternity package as well.

Remember that third-party payers may use ACOGs bundling determinations as a guideline but may not follow them to the letter. Carriers may deviate by adding additional codes that they feel should be part of the global package. Unfortunately, at times the only way for you to find out what some carriers determine bundled is through denials. Sometimes it is worthwhile to appeal a bundling or global package determination with the carrier using ACOGs guidelines as well as the national Correct Coding Initiative. Some carriers will reverse their thinking if they are questioned using these two sources of information for your disagreement with the denial.