Ob-Gyn Coding Alert

Question: We are having a dilemma at our hospital. We employ all of our physicians. If Dr. A starts care and sees the patient for all prenatal care and Dr. B delivers,we bill global under Dr. A and give relative value unit (RVU) credit to Dr B. Ive heard talk about switching this to billing global under the physician who delivers -- even if he has not ever seen the patient in the office. Is this the more correct way of billing these situations?

Colorado Subscriber

Answer: You should check with your payers, because you must follow their guidelines.

When billing globally, the attending of record is usually the one who bills, not the delivering physician (unless it is the same physician). This is how you seem to be doing it now and there is no reason to switch. Most payers have no problem with billing under the attending of record, because they are paying the global fee. The payment will not change, no matter whose billing number you report.

As some added information to assist you in assigning credit for the global service, CMS valued the global code (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) based on the following percentages:

" Antepartum care: 41 percent of the work

" Admission H&P and labor management: 36 percent of the work

" Vaginal delivery: 15 percent of the work

" Postpartum care (includes inpatient and outpatient visits): 8 percent of the work