Ob-Gyn Coding Alert

Question: If a global ob patient comes in for more than 13 prenatal visits, how should we report that? Do they have to be problem visits?

Tennessee Subscriber

Answer: Routine care is routine care. The normal range for a normal pregnancy can be 10-15 visits, even though the accepted standard for the global service is estimated to be 13 visits. This estimate is based on the patient presenting at 8 weeks for pregnancy care and delivering at 40 weeks with visit intervals being performed according to the CPT guidelines- definition.

You can only bill additional visits beyond the 13 included in the package (59400-59622) if the patient exhibits complications that require extra visits.

First, you could try billing every visit after the 13th that involves the management of the problem (such as gestational diabetes or bleeding) as an E/M service with the appropriate code for the complication.

Watch out: Your physician must have documented this in a manner that allows you to translate his wording unequivocally into an E/M service. Notes on the flow sheet are usually not adequate if you expect to get paid. Also, do not count any of the routine antepartum care when selecting the level of service.

If the payer rejects this form of billing, your only other choice is to add modifier 22 (Increased procedural services) to the global code after delivery.

Caution: Again, your submitted documentation should include the number of visits that exceeded the norm, the reason for the visits, and the service levels these would represent (and have the backup medical record handy to prove your claim). Some will pay, while others will not.