Ob-Gyn Coding Alert

Question: I need some guidance regarding billing the OB global package within a group practice. We have 4 MDs and 4 certified nurse midwives (CNMs), and they all rotate the patients during the antepartum care so the patient can meet all the providers prior to her delivery. If a midwife performs the actual vaginal delivery with no MD on site, can the global OB package be billed under one of the physicians, as opposed to the midwife?

I understand some carriers may have their own policy on this, but I’m looking for guidance as a coder and for compliance. One of the physicians feels that all deliveries should be billed under one of the MDs and not the midwife.

California Subscriber

Answer: You are correct that some payers stipulate how you must bill global ob packages (59400-59622), but normally in a group practice situation, the payer is paying you for global care. You won’t find any stipulation as to who gets to bill for it.

If the patient has been assigned one physician as her primary ob of record, you can usually still bill the global under that provider, so long as he/she has been active in the patient’s care during the pregnancy. Some Medicaid programs do not permit this, but most commercial payers will. The reason for this is usually because the billing provider impacts the payment you will receive (i.e., they say they will pay less if a CNM delivers). However, the ob of record is also on the hook for any risk issues, so be sure all parties understand this — especially if the CNM delivers and the patient has a complication.