Ob-Gyn Coding Alert

Question: I have a practice that is billing maternity global care. However, at times the patient, who has United Healthcare, does not come in for her 6 week postpartum visit. The provider is stating they still bill global in these cases. We feel this is not appropriate as the full package was not provided without the postpartum visit. What should I do?

North Carolina Subscriber

Answer: Many payers state that ob-gyns can bill for global even when the patient does not come back for the actual postpartum visit. They do not expect our providers to wait 6 weeks to bill for services, after determining if the patient will return to the office setting.

Here is information from the UHC Obstetrical Policy.

Q: Should a postpartum visit be provided within the ACOG standard six-week period? A: The postpartum period includes routine office or outpatient postpartum visit(s) usually, but not necessarily, performed 6 weeks following delivery. If a physician routinely performs more than one postpartum outpatient visit in an uncomplicated case, the extra visit(s) is not billed separately. When a postpartum visit is scheduled, but the patient does not keep the appointment, the physician’s documentation should reflect that the patient did not appear for the scheduled postpartum visit. This visit does not have to be refunded if a global OB code was previously submitted. If a patient returns to the office well after their scheduled postpartum visit (e.g., 6 months later) this visit may be reported separately since the global period would no longer apply. (Emphasis added.)