Ob-Gyn Coding Alert

This method keeps your pay coming in when another MD claims the delivery.

Still snag payment when your practices ob-gyn provides all the antepartum care while a covering MD performs the delivery by breaking down your practices agreements.

You may encounter three types of arrangements, said Glade B. Curtis, MD, MPH, FACOG, CPC, in Preparation for Accreditation at The Coding Institutes Ob-Gyn Coding and Reimbursement conference; how these arrangements work will affect how you code the global ob care.

Go With 59400 on Swap Agreement

An informal agreement is an Ill cover for you if you cover for me arrangement. No money changes hands, because both providers agree things will even out in time.

In this situation, you code the global service (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) under the ID of the ob-gyn on the patients record -- even though a covering MD performed the delivery. Be sure to check your states statutes or regulations to see if they allow this arrangement.

Stick With Global for Placeholder Care

In a locum tenens (Latin for placeholder) agreement, youll still report the ob global care with 59400 under the ob-gyns ID. The ob-gyn on record reimburses the covering MD, who is a temporary employee of the obgyns practice.

Before using locum tenens arrangements, check your major insurers policies. Not all payers recognize locum tenens, experts warn.

You might also see an arrangement where the ob-gyn on record contracts with a locum company, pays the company, and it takes care of arrangements to supply a covering MD. The company covers his malpractice, reimbursement, etc., and takes a cut of the ob-gyns pay, says Harry Stuber, MD, an independent gynecologist in Cookeville, Tenn.

Predetermine Out of Practice Delivery Carve Out

Youll need a letter of explanation to alert your payers when a physician who is not part of the practice performs the delivery. In this case, the covering MD codes for the delivery, while you report the antepartum and postpartum care under your ob-gyns ID.

Smart: If the coverage agreement is in writing and agreed upon before the actual services are performed, there are fewer chances of problems occurring later, says Cindy Foley, billing manager for three separate ob-gyn practices in Syracuse, N.Y.

You should alert your insurance carriers to the coverage situation. Some carriers reduce the allowed amounts when the services are carved out.

Solve Delivery Compensation Disputes

Sometimes you may have a dispute over who deserves the delivery compensation fee. When this happens, you have two choices:

Option 1: You can separately report each component of the global ob care. In other words, youll report the antepartum care (either 59425, Antepartum care only; 4-6 visits; or 59426, & 7 or more visits), the delivery of the placenta (59414, Delivery of placenta [separate procedure]), episiotomy repair (59300, Episiotomy or vaginal repair, by other than attending physician), and postpartum care (59430, Postpartum care only [separate procedure]).

Our practice reports each element individual if another physician did the actual delivery. That way, everyone knows what to expect monetarily, and if theres an error in payment, its easier to catch, Foley says.

Option 2: Or you can report the ob global service with modifier 52 (Reduced services) appended to 59400.

When Medicare assigned a value under the Resource- Based Relative Value Scale (RBRVS) for global ob package code 59400, they valued the components of the package as a percentage of the total work needed to provide complete ob care. They broke this code down as follows:

1. Antepartum care is 41 percent of the work 2. Admission H&P and labor management is 36 percent of the work

3. Vaginal delivery is 15 percent of the work

4. Postpartum care (includes inpatient and outpatient visits) is 8 percent of the work.

You can estimate your reduced services reimbursement accordingly. Your payer will likely deduct the percentage that your ob-gyn did not perform.

Bottom line: Before you apply the global code to your claim, you need to understand whether the covering provider will charge for his portion of the service.